Proposed a simple score for recommendation of scheduled ultrasonography surveillance for hepatocellular carcinoma after Direct Acting Antivirals: multicenter analysis

Hiraoka, Atsushi; Kumada, Takashi; Ogawa, Chikara; Kariyama, Kazuya; Morita, Masahiro; Nouso, Kazuhiro; Toyoda, Hidenori; Tada, Toshifumi; Ochi, Marie; Murakami, Taisei; Izumoto, Hirofumi; Ueki, Hidetaro; Kitahata, Shogo; Aibiki, Toshihiko; Okudaira, Taeko; Yamago, Hiroka; Iwasaki, Ryuichiro; Tomida, Hideomi; Miyamoto, Yuji; Mori, Kenichiro; Miyata, Hideki; Tsubouchi, Eiji; Kishida, Masato; Nakamura, Tomoyuki; Michitaka, Kojiro

doi:10.1111/jgh.14378

Cited by 26 publications

(46 citation statements)

References 27 publications

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“…Furthermore, following multivariate analysis, age and AFP serum level after DAA treatment were identified as independent risk factors for HCC occurrence. These results were consistent with previous studies, which reported that elderly patients have a higher risk of developing HCC after antiviral treatment (22,23,33,34).…”

Section: Discussionsupporting

confidence: 93%

“…The cumulative incidence of HCC increased significantly with higher scores (P<0.001). Previous studies have reported a stratification of HCC occurrence rate by scoring with FIB-4 and AFP after SVR or sex (31,34). However, compared with other reports, the scoring system established in the present study is simple and concise, and uses only two factors (advanced age and AFP levels after DAA treatment) to predict the risk of HCC occurrence after SVR.…”

Section: Discussionmentioning

confidence: 84%

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Simple scoring system for prediction of hepatocellular carcinoma occurrence after hepatitis C virus eradication by direct‑acting antiviral treatment: All Kagawa Liver Disease Group Study

et al. 2020

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Direct acting antivirals (DAA) have recently been developed to treat patients with hepatitis C virus (HCV) infection, and interferon-free DAA treatment has improved the cure rate of patients. However, the occurrence rate of hepatocellular carcinoma (HCC) following HCV eradication remains unknown. Therefore, the present study aimed to identify predictors of HCC occurrence following DAA treatment. Among 1,454 patients infected with HCV, 1,088 patients who achieved sustained virologic response and who had no history of HCC treatment were recruited between September 2014 and November 2018. The incidence of HCC in patients infected with HCV following DAA treatment, and the predictors contributing to HCC occurrence were identified using clinicopathological characteristics and blood test results. During the present study, 26 patients developed HCC. The incidence of HCC was 0.61, 1.88, 2.82 and 3.71% at 6, 12, 18 and 24 months after treatment with DAA, respectively. The results of multivariate analysis identified age [hazard ratio (HR), 1.0729; P=0.0044] and α-fetoprotein (AFP) level after DAA treatment (HR, 1.0486; P=0.0486) as independent factors that may contribute to HCC occurrence following DAA treatment. By using these two factors, a novel scoring system (0-2 points) was established to predict HCC occurrence following HCV eradication by DAA treatment. The incidence of HCC at 2 years was 0.3% in the 0 points group, 6.27% in the 1 point group and 18.37% in the 2 points group. In conclusion, AFP level after DAA treatment and age at DAA administration were identified as independent predictors of HCC occurrence in patients that were treated with DAA. The scoring system that was established in the present study is simple and easy, and using pre-treatment factors may be a convenient tool to predict the risk of HCC occurrence in HCV-free patients following DAA treatment.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 84%

Simple scoring system for prediction of hepatocellular carcinoma occurrence after hepatitis C virus eradication by direct‑acting antiviral treatment: All Kagawa Liver Disease Group Study

et al. 2020

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“…It has long been known that, among patients with chronic liver disease, fluctuating or persistently elevated levels of AFP identify those at higher risk, 30,31 and AFP, alone or combined with other tumor markers, has been incorporated in models predicting HCC development in unselected cirrhotic 32 and hepatitis C virus (HCV)-infected patients. [33][34][35][36] However, because of their suboptimal accuracy and/or lack of external validation, these models are not routinely used to select patients for cost-effective surveillance.…”

Section: Alpha-fetoprotein As a Marker Of Cancer Riskmentioning

confidence: 99%

“…Unfortunately, although the biomarker has been incorporated into several multifactorial risk scores, [32][33][34][35][36] very few data are currently available on this specific topic. In a simulated model of carcinogenesis proposed for HCVinfected patients, an AFP level !20 ng/mL approximately doubled the HCC risk at 5 and 10 years in patients with either the lowest risk (women younger than 54 years, with platelet count !100,0000/mmc) or the highest risk (men older than 55 years, with platelet count <100,0000/mmc).…”

Section: Alpha-fetoprotein As a Marker Of Cancer Riskmentioning

confidence: 99%

Alpha-fetoprotein for Diagnosis, Prognosis, and Transplant Selection

2019

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Reliable biomarkers are of great clinical value in predicting cancer occurrence/recurrence, anticipating its detection at an asymptomatic stage, supporting the radiological diagnosis, stratifying patients for prognosis and proper therapy, and measuring the response to treatment. Despite the plethora of biomarkers proposed for hepatocellular carcinoma (HCC), the first one identified, α-fetoprotein (AFP), remains the most utilized. This article reviews the lights and shadows of AFP as a surveillance test for patients at risk of HCC, and as a diagnostic test for those with chronic liver disease and a suspected hepatic mass. Moreover, the article scrutinizes the large body of evidence supporting the prognostic relevance of AFP in patients undergoing both curative and palliative treatment of HCC and the growing importance attributed to this biomarker (as a static or a dynamic variable) in the selection of potential candidates for liver transplantation. In fact, the inclusion of AFP among transplant criteria would improve the ability of identifying poor candidates due to an unacceptable risk of HCC recurrence regardless of tumor burden, and of adopting flexible morphological selection criteria.

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“… 59 In addition, three Japanese studies reported that post-SVR FIB-4 (at EOT and at SVR12) and changes in FIB-4 independently predicted de-novo HCC. 50 , 55 , 60 Among investigated serological biomarkers of fibrosis was Wisteria floribunda agglutinin positive Mac-2 (WFA*M2BP), which was tested in the study by Nagata et al, reporting that WFA*M2BP assessed 24 weeks after EOT independently predicted de-novo HCC 55 ( Tables 5 and 6 ).…”

Section: Predictors Of De-novo Hccmentioning

confidence: 99%

Predicting Hepatocellular Carcinoma Risk in Patients with Chronic HCV Infection and a Sustained Virological Response to Direct-Acting Antivirals

D’Ambrosio¹,

Degasperi²,

Lampertico³

2021

JHC

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Chronic infection with hepatitis C virus (HCV) may complicate with hepatocellular carcinoma (HCC), especially in patients with cirrhosis. Although the achievement of a sustained virological response (SVR) had been associated with a reduction in the risk of HCC already in the Interferon era, some concerns initially raised following the use of direct-acting antivirals (DAA), as their use was associated with increased risk of HCC development and aggressiveness. However, studies demonstrated that the risk of HCC was strongly influenced by pre-treatment fibrosis stage and, eventually, prior HCC history more than the type of antiviral therapy. According to published studies, rates of de-novo HCC ranged between 1.4% and 13.6% in patients with cirrhosis or advanced fibrosis vs 0.9% and 5.9% in those with chronic hepatitis C (CHC). Conversely, rates of recurrent HCC were higher, ranging between 3.2% and 49% in cirrhotics vs 0% and 40% in CHC patients. Most studies tried to identify predictors of HCC development, either de-novo or recurrent, and some authors were also able to build predictive scores for HCC risk stratification, which however still need prospective validation. Whereas some clinical features, such as age, gender, presence of comorbidities and fibrosis stage, may influence both de-novo and recurrent HCC, previous tumour burden before DAA seems to prevail over these features in recurrent HCC risk prediction.

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Proposed a simple score for recommendation of scheduled ultrasonography surveillance for hepatocellular carcinoma after Direct Acting Antivirals: multicenter analysis

Abstract: The present ADRES score was simple and easy to use and may be useful for predicting risk of HCC development in short term after reaching SVR24 by DAAs.

Cited by 26 publications

References 27 publications

Simple scoring system for prediction of hepatocellular carcinoma occurrence after hepatitis C virus eradication by direct‑acting antiviral treatment: All Kagawa Liver Disease Group Study

Simple scoring system for prediction of hepatocellular carcinoma occurrence after hepatitis C virus eradication by direct‑acting antiviral treatment: All Kagawa Liver Disease Group Study

Alpha-fetoprotein for Diagnosis, Prognosis, and Transplant Selection

Predicting Hepatocellular Carcinoma Risk in Patients with Chronic HCV Infection and a Sustained Virological Response to Direct-Acting Antivirals

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