High serum alanine aminotransferase levels for the first three successive years can predict very high incidence of hepatocellular carcinoma in patients with Child Stage A HCV-associated liver cirrhosis

Abstract

Objective. To assess retrospectively whether continuously high serum alanine aminotransferase (ALAT) levels (<80 IU) in the first three successive years after the diagnosis of liver cirrhosis (LC) are predictive of a subsequent high incidence of hepatocellular carcinoma (HCC) in patients with Child Stage A hepatitis C virus (HCV)-LC. Material and methods. The study comprised 132 HCV-LC (Child Stage A) patients who had not received interferon therapy but had been treated with anti-inflammatory agents. At the end of a 3-year follow-up after the diagnosis of LC, the patients were subdivided into three groups according to their serum ALAT levels and the subsequent incidence of HCC was assessed. Results. The cumulative incidence of HCC starting from 3 years after the diagnosis of LC in the continuously high ALAT group (annual average over 3 years always > or =80 IU; n=41; Group A) was markedly higher than that in the continuously low ALAT group (always <80 IU; n=48; Group B) (p<0.005) during an observation period of 7.9+/-3.7 years. The incidence of HCC in Group A was 11.8%/year. The odds ratios of developing HCC in Group A and Group C (mixed high and low ALAT levels; n=43) were 5.1-fold and 1.5-fold that of Group B, respectively. A multivariate analysis revealed that the ALAT group was independently associated with HCC development. Conclusions. Continuously high ALAT levels for three successive years following the diagnosis of LC can be predictive of a very high incidence of HCC in Child A HCV-LC patients. Prospective trials using therapeutic approaches aimed at decreasing ALAT levels are necessary in order to confirm a positive impact of ALAT reduction on the incidence of HCC in patients with HCV-LC.

Protective effects of fermented rice vinegar sediment (Kurozu moromimatsu) in a diethylnitrosamine-induced hepatocellular carcinoma animal model

“…For example, the occurrence rate of HCC in LC patients with HCV infection is 6–8%/year in Japan. (12) In patients with hepatitis, inflammation and regeneration in the liver are associated with development of HCC, (13) though exceptionally, HCC rarely develops in patients with autoimmune hepatitis. However, our study revealed that the extents of histological liver fibrosis or inflammatory change, as well as the serum levels of transaminases or hyaluronic acid as a marker of liver fibrosis, were not significantly different between the Kurozu-M group and the control.…”

Severe Inflammation in the Background Liver Cirrhosis Correlates with the Development of Poorly Differentiated HCC in HCV-Associated Liver Cirrhosis

“…With regard to the relationship between the severe inflammation and the HCC development in HCV-related chronic liver diseases, many studies have demonstrated the close association between severe inflammation as estimated by higher serum alanine aminotransferase level and initiation of HCC development (13)(14)(15). However, no study has ever demonstrated the relationship between severe inflammation and the promotion of HCC tumor in HCV-related chronic liver diseases.…”

Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

“…They confirmed that high levels of AFP, transaminases and LS are excellent predictors of HCC but underlined the importance of interquartile range (IQR) in LSMs. This led to the hypothesis of “stiffness shadow” that indicated an inhomogeneous shear stress due to the chaotic tumoral growth in the already hard cirrhotic tissue, with relevant diagnostic repercussions[ 81 , 82 ]. The overall prognostic model combining the four variables demonstrated relevant results both in the training and validation phase with a positive relation with tumor size.…”