BACKGROUND: Noninvasive risk factors are required for predicting the development of hepatocellular carcinoma (HCC) not only in patients with cirrhosis but also in those with chronic hepatitis who are infected with hepatitis C virus (HCV). METHODS: A total of 707 patients with chronic HCV infection without other risks were evaluated for the predictive value of noninvasive risk factors for HCC, including age, sex, viral load, genotype, fibrosis stage, aspartate and alanine aminotransferase levels, bilirubin, albumin, platelet count, and alpha-fetoprotein (AFP) at entry to the study, as well as interferon (IFN) therapy they received. RESULTS: The ten-year cumulative incidence rates of HCC for patients with fibrosis stages F0/F1, F2, F3, and F4 were 2.5, 12.8, 19.3, and 55.9%, respectively. Multivariate analysis identified age ≥57 years [hazard ratio (HR) 2.026, P = 0.004], fibrosis stage F4 (HR 3.957, P < 0.001), and AFP 6-20 ng/mL (HR 1.942, P = 0.030) and ≥20 ng/mL (HR 3.884, P < 0.001), as well as the response to IFN [relative risk (RR) 0.099, P < 0.001], as independent risk factors for the development of HCC. The ten-year cumulative incidence rates of HCC in the patients with AFP levels of <6, 6-20, and ≥20 ng/mL at entry were 6.0, 24.6, and 47.3%, respectively. CONCLUSIONS: Not only high (>20 ng/mL), but also even slightly elevated (6-20 ng/mL) AFP levels, could serve as a risk factor for HCC to complement the fibrosis stage. In contrast, AFP levels <6 ng/mL indicate a low risk of HCC development in patients infected with HCV, irrespective of the fibrosis stage.
BACKGROUND: Noninvasive risk factors are required for predicting the development of hepatocellular carcinoma (HCC) not only in patients with cirrhosis but also in those with chronic hepatitis who are infected with hepatitis C virus (HCV). METHODS: A total of 707 patients with chronic HCV infection without other risks were evaluated for the predictive value of noninvasive risk factors for HCC, including age, sex, viral load, genotype, fibrosis stage, aspartate and alanine aminotransferase levels, bilirubin, albumin, platelet count, and alpha-fetoprotein (AFP) at entry to the study, as well as interferon (IFN) therapy they received. RESULTS: The ten-year cumulative incidence rates of HCC for patients with fibrosis stages F0/F1, F2, F3, and F4 were 2.5, 12.8, 19.3, and 55.9%, respectively. Multivariate analysis identified age ≥57 years [hazard ratio (HR) 2.026, P = 0.004], fibrosis stage F4 (HR 3.957, P < 0.001), and AFP 6-20 ng/mL (HR 1.942, P = 0.030) and ≥20 ng/mL (HR 3.884, P < 0.001), as well as the response to IFN [relative risk (RR) 0.099, P < 0.001], as independent risk factors for the development of HCC. The ten-year cumulative incidence rates of HCC in the patients with AFP levels of <6, 6-20, and ≥20 ng/mL at entry were 6.0, 24.6, and 47.3%, respectively. CONCLUSIONS: Not only high (>20 ng/mL), but also even slightly elevated (6-20 ng/mL) AFP levels, could serve as a risk factor for HCC to complement the fibrosis stage. In contrast, AFP levels <6 ng/mL indicate a low risk of HCC development in patients infected with HCV, irrespective of the fibrosis stage.
Authors: M L Shiffman; C M Hofmann; M J Contos; V A Luketic; A J Sanyal; R K Sterling; A Ferreira-Gonzalez; A S Mills; C Garret Journal: Gastroenterology Date: 1999-11 Impact factor: 22.682
Authors: Adrian M Di Bisceglie; Richard K Sterling; Raymond T Chung; James E Everhart; Jules L Dienstag; Herbert L Bonkovsky; Elizabeth C Wright; Gregory T Everson; Karen L Lindsay; Anna S F Lok; William M Lee; Timothy R Morgan; Marc G Ghany; David R Gretch Journal: J Hepatol Date: 2005-09 Impact factor: 25.083
Authors: H Tsukuma; T Hiyama; S Tanaka; M Nakao; T Yabuuchi; T Kitamura; K Nakanishi; I Fujimoto; A Inoue; H Yamazaki Journal: N Engl J Med Date: 1993-06-24 Impact factor: 91.245
Authors: M Colombo; R de Franchis; E Del Ninno; A Sangiovanni; C De Fazio; M Tommasini; M F Donato; A Piva; V Di Carlo; N Dioguardi Journal: N Engl J Med Date: 1991-09-05 Impact factor: 91.245
Authors: Y Imai; S Kawata; S Tamura; I Yabuuchi; S Noda; M Inada; Y Maeda; Y Shirai; T Fukuzaki; I Kaji; H Ishikawa; Y Matsuda; M Nishikawa; K Seki; Y Matsuzawa Journal: Ann Intern Med Date: 1998-07-15 Impact factor: 25.391
Authors: Jagpreet Chhatwal; Shannon A Ferrante; Cliff Brass; Antoine C El Khoury; Margaret Burroughs; Bruce Bacon; Rafael Esteban-Mur; Elamin H Elbasha Journal: Value Health Date: 2013 Sep-Oct Impact factor: 5.725