Yuki Yamashita1, Satoru Joshita1, Ayumi Sugiura1, Tomoo Yamazaki1, Hiroyuki Kobayashi1, Shun-Ichi Wakabayashi1, Yosuke Yamada2, Soichiro Shibata3, Hideo Kunimoto4, Takanobu Iwadare4, Makiko Matsumura5, Chiharu Miyabayashi6, Taiki Okumura7, Sachie Ozawa8, Yuichi Nozawa9, Natsuko Kobayashi10, Michiharu Komatsu11, Naoyuki Fujimori12, Hiromi Saito13, Takeji Umemura1,14. 1. Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan. 2. Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Japan. 3. Department of Gastroenterology, Japanese Red Cross Society Nagano Hospital, Nagano, Japan. 4. Department of Gastroenterology, Nagano Municipal Hospital, Nagano, Japan. 5. Department of Gastroenterology, Nagano Chuo Hospital, Nagano, Japan. 6. Department of Gastroenterology, Chikuma Central Hospital, Chikuma, Japan. 7. Department of Gastroenterology, NHO Matsumoto Medical Center, Matsumoto, Japan. 8. Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan. 9. Department of Gastroenterology, Ina Central Hospital, Ina, Japan. 10. Department of Gastroenterology, Kenwakai Hospital, Iida, Japan. 11. Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Suwa, Japan. 12. Department of Gastroenterology, NHO Shinshu Ueda Medical Center, Ueda, Japan. 13. Department of Gastroenterology, Aizawa Hospital, Matsumoto, Japan. 14. Department of Life Innovation, Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.
Abstract
AIMS: Hepatocellular carcinoma (HCC) can still occur in hepatitis C virus (HCV) patients who have achieved a sustained virologic response (SVR), which remains an important clinical issue in the direct-acting antivirals era. The current study investigated the clinical utility of the aMAP score (consisting of age, male, albumin-bilirubin, and platelets) for predicting HCC occurrence in HCV patients achieving an SVR by direct-acting antivirals. METHODS: A total of 1113 HCV patients without HCC history, all of whom achieved an SVR, were enrolled for clinical comparisons. RESULTS: Hepatocellular carcinoma was recorded in 50 patients during a median follow-up period of 3.7 years. The aMAP score was significantly higher in the HCC occurrence group than in the HCC-free group (53 vs. 47, p < 0.001). According to risk stratification based on aMAP score, the cumulative incidence of HCC occurrence for the low-, medium-, and high-risk groups was 0.14%, 4.49%, and 9.89%, respectively, at 1 year and 1.56%, 6.87%, and 16.17%, respectively, at 3 years (low vs. medium, low vs. high, and medium vs. high: all p < 0.01). Cox proportional hazard analysis confirmed aMAP ≥ 50 (hazard ratio [HR]: 2.78, p = 0.014), age≥ 70 years (HR: 2.41, p = 0.028), ALT ≥ 17 U/L (HR: 2.14, p < 0.001), and AFP ≥ 10 ng/mL (HR: 2.89, p = 0.005) as independent risk factors of HCC occurrence. Interestingly, all but one patient (99.5%) with aMAP less than 40 was HCC-free following an SVR. CONCLUSION: The aMAP score could have clinical utility for predicting HCC occurrence in HCV patients achieving an SVR.
AIMS: Hepatocellular carcinoma (HCC) can still occur in hepatitis C virus (HCV) patients who have achieved a sustained virologic response (SVR), which remains an important clinical issue in the direct-acting antivirals era. The current study investigated the clinical utility of the aMAP score (consisting of age, male, albumin-bilirubin, and platelets) for predicting HCC occurrence in HCVpatients achieving an SVR by direct-acting antivirals. METHODS: A total of 1113 HCVpatients without HCC history, all of whom achieved an SVR, were enrolled for clinical comparisons. RESULTS:Hepatocellular carcinoma was recorded in 50 patients during a median follow-up period of 3.7 years. The aMAP score was significantly higher in the HCC occurrence group than in the HCC-free group (53 vs. 47, p < 0.001). According to risk stratification based on aMAP score, the cumulative incidence of HCC occurrence for the low-, medium-, and high-risk groups was 0.14%, 4.49%, and 9.89%, respectively, at 1 year and 1.56%, 6.87%, and 16.17%, respectively, at 3 years (low vs. medium, low vs. high, and medium vs. high: all p < 0.01). Cox proportional hazard analysis confirmed aMAP ≥ 50 (hazard ratio [HR]: 2.78, p = 0.014), age≥ 70 years (HR: 2.41, p = 0.028), ALT ≥ 17 U/L (HR: 2.14, p < 0.001), and AFP ≥ 10 ng/mL (HR: 2.89, p = 0.005) as independent risk factors of HCC occurrence. Interestingly, all but one patient (99.5%) with aMAP less than 40 was HCC-free following an SVR. CONCLUSION: The aMAP score could have clinical utility for predicting HCC occurrence in HCVpatients achieving an SVR.