Prediction model for hepatocellular carcinoma occurrence in patients with hepatitis C in the era of direct‐acting anti‐virals

Tahata, Yuki; Sakamori, Ryotaro; Yamada, Ryotaro; Kodama, Tatsuhiko; Hagiwara, Hideki; Imai, Yumiko; Hiramatsu, Naoki; Tamura, Shinji; Yamamoto, Keiji; Oshita, Masahide; Ohkawa, Kazuyoshi; Hijioka, Taizo; Fukui, Hirokazu; Ito, Toshifumi; Doi, Yoshinori; Yamada, Yukinori; Yakushijin, Takayuki; Yoshida, Yasuhiko; Tatsumi, Tomohide; Takehara, Tetsuo

doi:10.1111/apt.16632

Cited by 22 publications

(30 citation statements)

References 31 publications

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“…We previously reported that AFP levels at SVR was an independent predictor for HCC incidence in patients treated with DAA, including patients with and without advanced liver fibrosis. 14 The AFP level at SVR could be a surrogate marker of HCC incidence, even in patients without advanced liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…These cut-off values were set based on previous reports. 14,27,28 We undertook statistical analyses using SPSS version 24.0 (IBM), and considered a two-tailed p-value less than 0.05 to be statistically significant in all analyses.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Sustained virologic response (SVR) can be achieved with direct-acting antiviral (DAA) treatment in almost all patients with hepatitis C virus (HCV) infection [1][2][3][4][5][6][7] ; however, the development of hepatocellular carcinoma (HCC) has been reported in some patients who achieve SVR. [8][9][10][11] Several studies have reported that liver fibrosis is one of the most important predictors for HCC after SVR, [12][13][14][15] and the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of Liver (EASL) guidelines describe the need for HCC surveillance based on the degree of liver fibrosis. 16,17 For patients with fibrosis score F4, who were diagnosed with clinical, histological, and liver stiffness measurement or fibrosis-4 (FIB-4) index ≥3.…”

Section: Introductionmentioning

confidence: 99%

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Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis

Tahata

Sakamori

Yamada

et al. 2022

Hepatology Research

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Aim Hepatocellular carcinoma (HCC) after sustained virologic response (SVR) has been observed even in hepatitis C virus (HCV) patients without advanced liver fibrosis. Identifying predictors for HCC incidence in patients without advanced liver fibrosis will enable efficient post‐SVR HCC surveillance. This study aimed to develop a scoring system to predict the incidence of HCC after SVR in HCV patients without advanced liver fibrosis. Methods A total of 1682 HCV patients without advanced liver fibrosis (defined as Fibrosis‐4 index <3.25) with no history of HCC who initiated direct‐acting antiviral treatment between September 2014 and October 2020 at 26 institutions, and achieved SVR24, were included. We divided 1682 patients into training (1122) and validation (560) cohorts. Results In the multivariate analysis, baseline age ≥ 65 years (p = 0.030), alanine aminotransferase (ALT) levels at SVR24 ≥ 30 U/l (p = 0.001), and α‐fetoprotein (AFP) levels at SVR24 ≥ 5.0 ng/ml (p = 0.001) were independent predictors for HCC incidence in the training cohort. We developed a scoring system to predict HCC incidence after SVR24 using these three factors (1 point was added for each factor). The cumulative HCC incidence rates at 5 years were 7.1% in patients who scored 2 or 3, and no patients developed HCC in those who scored 0 in the validation cohort. Conclusions Our scoring system using the three factors of baseline age, ALT levels at SVR, and AFP levels at SVR is useful for post‐SVR HCC surveillance of patients without advanced liver fibrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis

Tahata

Sakamori

Yamada

et al. 2022

Hepatology Research

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“…All the additional data required for such model refinement is available and we are currently investigating this possibility. Our analysis suggests the aMAP score possesses all the qualities required for practical risk stratification in HCC surveillance [31].…”

Section: Discussionmentioning

confidence: 87%

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

et al. 2022

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Background and aims The aMAP score is a model that predicts risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis. Its performance in a ‘real world’ surveillance setting has not yet been ascertained. Patients and methods We had access to a cohort of 3473 individuals enrolled in a rigorously implemented and prospectively accrued surveillance programme (patients undergoing regular ultrasound and biomarker examination between 1998 and 2021). During this period 445 had HCC detected. Of these, 77.8% had early stage disease (within Milan criteria), permitting potentially curative therapy to be implemented in nearly 70% of cases. We applied the recently developed aMAP score to classify patients according to their initial aMAP score in to low, medium and high-risk groups as proposed in the original publication. The performance of the aMAP score was assessed according to the concordance-index and calibration (i.e. agreement between observed and predicted risk). Allowance was made for competing causes of death. Results The aMAP score achieved an overall C-index of 0.81 (95% CI: 0.79–0.82) consistent with the initial report and was unaffected by allowance for competing causes of death. Sub-group analysis showed that the results did not change significantly according to gender, or aetiology. However, aMAP discrimination was greater for younger individuals (versus older individuals), and also for individuals without cirrhosis. The HCC incidence rate was 0.98, 7.05 and 29.1 events per 1000 person-years in the low-, moderate- and high-risk aMAP groups, respectively. Conclusions The results from this ‘real-world’ cohort demonstrate that risk stratification is a realistic prospect and that identification of a subgroup of chronic liver disease patients who have a very low risk of HCC is feasible.

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“…Another study, from Tani et al, used a simple scoring system based on age of HCV patients and AFP level after DAA treatment to select patients with a high risk of HCC development [61]. Finally, a prediction model combining body mass index, FIB-4, and albumin and AFP level at sustained response time points was recently proposed as an efficient surveillance strategy for HCC occurrence after DAA treatment [62].…”

Section: Predictive Models and Scoresmentioning

confidence: 99%

Predictive Factors for Hepatocellular Carcinoma Development after Direct-Acting Antiviral Treatment of HCV

Jilkova

Saleem

Afzal

et al. 2021

Livers

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Chronic hepatitis C virus infection is still one of the major risk factors for the development of hepatocellular carcinoma (HCC), the most frequent type of primary liver cancer. Direct-acting antivirals have substantially improved the cure rate of the virus, but the risk of hepatitis C virus-related HCC remains high, mainly in patients with advanced liver fibrosis and cirrhosis. HCC is often asymptomatic and, therefore, remains undetected until the late tumor stage, which is associated with poor survival rates. Therefore, to improve the surveillance programs following HCV eradication, there is a need to summarize predictive factors or potential biomarkers, to specifically identify patients likely to develop HCC after direct-acting antiviral treatment. This review outlines the most recent data about different predictive factors for HCC development after direct-acting antiviral treatment of hepatitis C virus-infected patients, to improve the clinical management of patients with chronic hepatitis C virus.

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Prediction model for hepatocellular carcinoma occurrence in patients with hepatitis C in the era of direct‐acting anti‐virals

Cited by 22 publications

References 31 publications

Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis

Risk of hepatocellular carcinoma after sustained virologic response in hepatitis C virus patients without advanced liver fibrosis

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

Predictive Factors for Hepatocellular Carcinoma Development after Direct-Acting Antiviral Treatment of HCV

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