Gut Liver.  2016 Sep;10(5):796-802. 10.5009/gnl15368.

Prediction of the Risk of Hepatocellular Carcinoma in Chronic Hepatitis C Patients after Sustained Virological Response by Aspartate Aminotransferase to Platelet Ratio Index

• Lee K
• Sinn DH
• Gwak GY
• Cho HC
• Jung SH
• Paik YH
• Choi MS
• Lee JH
• Koh KC
• Paik SW

• KMID: 2412078
• DOI: http://doi.org/10.5009/gnl15368

Abstract

BACKGROUND/AIMS
Following sustained virological response (SVR) for chronic hepatitis C (CHC) infection, patients with advanced fibrosis require regular monitoring for hepatocellular carcinoma (HCC). The aspartate aminotransferase to platelet ratio index (APRI) is a simple noninvasive surrogate marker known to reflect fibrosis.
METHODS
We retrospectively analyzed 598 patients who achieved SVR with interferon-based therapy for CHC.
RESULTS
Over a median of 5.1 years of follow-up, there were eight patients diagnosed with HCC and a 5-year cumulative incidence rate of 1.3%. The median pretreatment APRI was 0.83, which decreased to 0.29 after achieving SVR (p<0.001). Both the pre- and posttreatment indices were associated with HCC development. The 5-year cumulative HCC incidence rates were 0% and 2.8% for patients with pretreatment APRI <1.0 and ≥1.0, respectively (p=0.001) and 0.8% and 12.8% for patients with posttreatment APRI <1.0 and ≥1.0, respectively (p<0.001). Pretreatment APRI at a cutoff of 1.0 had a 100% negative predictive value until 10 years after SVR.
CONCLUSIONS
HCC development was observed among CHC patients who achieved SVR. The pre- and post-treatment APRI could stratify HCC risk, indicating that the APRI could be a useful marker to classify HCC risk in CHC patients who achieved SVR. However, given the small number of HCC patients, this finding warrants further validation.

Keyword

Carcinoma; hepatocellular; Aspartate aminotransferase to platelet ratio index; Hepatitis C; chronic; Sustained virological response

MeSH Terms

Adult
Antiviral Agents/therapeutic use
Aspartate Aminotransferases/*blood
Biomarkers/blood
Carcinoma, Hepatocellular/epidemiology/*virology
Female
Follow-Up Studies
Hepacivirus/drug effects
Hepatitis C, Chronic/*blood/complications/drug therapy/*enzymology
Humans
Incidence
Liver Neoplasms/epidemiology/*virology
Male
Middle Aged
Platelet Count
Retrospective Studies
Risk Factors
*Severity of Illness Index
Sustained Virologic Response
Antiviral Agents
Biomarkers
Aspartate Aminotransferases