Yasui Yutaka, Kurosaki Masayuki, Komiyama Yasuyuki, Takada Hitomi, Tamaki Nobuharu, Watakabe Keiya, Okada Mao, Wang Wan, Shimizu Takao, Kubota Yohei, Higuchi Mayu, Takaura Kenta, Tsuchiya Kaoru, Nakanishi Hiroyuki, Takahashi Yuka, Itakura Jun, Enomoto Nobuyuki, Izumi Namiki
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan.
Hepatol Res. 2018 Dec;48(13):1131-1139. doi: 10.1111/hepr.13233. Epub 2018 Aug 23.
The aim of this study is to clarify the value of serum Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA -M2BP) for predicting hepatocellular carcinoma (HCC) in chronic hepatitis C patients who achieved sustained virologic response (SVR) by therapy with interferon-free, direct-acting antivirals (DAAs).
This is a retrospective cohort study that included 567 patients who underwent antiviral therapy with an interferon-free DAA regimen and achieved SVR. Serum WFA -M2BP was measured after SVR. Factors predictive of HCC occurrence and recurrence were analyzed in the patients after stratification by previous treatment history of HCC.
Among 518 patients who had no history of HCC, 13 developed HCC. Post-SVR WFA -M2BP ≥1.75 cut-off index (C.O.I., P < 0.001) and α-fetoprotein (AFP) level ≥6 ng/mL (P = 0.01) were significant predictors of HCC development. Multivariate analysis showed that post-SVR WFA -M2BP ≥1.75 C.O.I. was an independent factor significantly associated with the development of HCC (hazard ratio [HR] 6.0; 95% confidence interval (CI), 1.8-19.4; P = 0.003). Among 49 patients who had a previous history of HCC, 22 had recurrence after SVR. Post-SVR AFP ≥6 ng/mL was the only factor associated with recurrence-free survival (HR 3.1; 95% CI, 1.3-7.5; P = 0.01).
Post-SVR WFA -M2BP is a predictive factor for the development of HCC in patients with no previous HCC history and treated with DAAs. Post-SVR AFP was predictive for HCC recurrence after DAA therapy.
本研究旨在阐明血清紫藤凝集素阳性Mac-2结合蛋白（WFA-M2BP）对于预测经无干扰素直接抗病毒药物（DAA）治疗获得持续病毒学应答（SVR）的慢性丙型肝炎患者发生肝细胞癌（HCC）的价值。
这是一项回顾性队列研究，纳入了567例接受无干扰素DAA方案抗病毒治疗并获得SVR的患者。SVR后检测血清WFA-M2BP。根据既往HCC治疗史对患者进行分层，分析HCC发生和复发的预测因素。
在518例无HCC病史的患者中，13例发生了HCC。SVR后WFA-M2BP≥1.75临界指数（C.O.I.，P＜0.001）和甲胎蛋白（AFP）水平≥6 ng/mL（P = 0.01）是HCC发生的显著预测因素。多因素分析显示，SVR后WFA-M2BP≥1.75 C.O.I.是与HCC发生显著相关的独立因素（风险比[HR] 6.0；95%置信区间[CI]，1.8 - 19.4；P = 0.003）。在49例既往有HCC病史的患者中，22例在SVR后复发。SVR后AFP≥6 ng/mL是与无复发生存相关的唯一因素（HR 3.1；95% CI，1.3 - 7.5；P = 0.01）。
SVR后WFA-M2BP是既往无HCC病史且接受DAA治疗患者发生HCC的预测因素。SVR后AFP可预测DAA治疗后HCC复发。
