Tachi Yoshihiko, Hirai Takanori, Kojima Yuko, Ishizu Yoji, Honda Takashi, Kuzuya Teiji, Hayashi Kazuhiko, Ishigami Masatoshi, Goto Hidemi
Department of Gastroenterology Komaki City Hospital Komaki Japan.
Department of Gastroenterology and Hepatology Nagoya University School of Medicine Nagoya Japan.
JGH Open. 2017 Sep 18;1(1):44-49. doi: 10.1002/jgh3.12007. eCollection 2017 Sep.
Predictive factors for hepatocarcinogenesis following eradication of hepatitis C virus by direct-acting antivirals (DAAs) are unknown. The aim of the study was to investigate the relationships between liver stiffness (LS) using acoustic radiation force impulse (ARFI) erastograghy and the development of hepatocellular carcinoma (HCC) in patients who achieved sustained virological response (SVR) treated with DAA.
In this prospective study, we enrolled 263 hepatitis C patients with SVR who underwent ARFI before DAA treatment. Thirty patients had previous HCC.
The median LS value according to ARFI measurements was 1.34 m/s (range: 0.67-4.35). During the follow-up period (median: 18.1 months), development of HCC occurred in 19 patients (7.2%; HCC occurrence in 7 patients and HCC recurrence in 12 patients). By multivariate Cox regression analysis, HCC history (hazard ratio [HR]: 10.634; 95% confidence interval [CI]: 4.13-27.37; = 0.001), older age (HR: 4.638; 95% CI: 1.63-13.61; = 0.004) and higher total bilirubin levels (HR: 4.189; 95% CI: 1.66-10.60; = 0.002) were independent predictors for the development of HCC, and higher LS value (≥1.73 m/s) at baseline was an independent predictor for HCC occurrence (HR: 8.350; 95% CI: 1.62-43.09; = 0.011). The cumulative recurrence of HCC was statistically similar according to the degree of LS in patients who were previously treated for HCC.
The LS value at baseline is useful for predicting HCC occurrence. Thus, even if SVR is achieved, patients with higher LS at baseline must be followed carefully for HCC occurrence.
直接作用抗病毒药物（DAA）根除丙型肝炎病毒后肝癌发生的预测因素尚不清楚。本研究旨在探讨应用声辐射力脉冲（ARFI）弹性成像测定的肝脏硬度（LS）与接受DAA治疗并获得持续病毒学应答（SVR）的患者肝细胞癌（HCC）发生之间的关系。
在这项前瞻性研究中，我们纳入了263例接受DAA治疗前接受ARFI检查的丙型肝炎SVR患者。30例患者曾患HCC。
根据ARFI测量，LS值中位数为1.34 m/s（范围：0.67 - 4.35）。在随访期（中位数：18.1个月）内，19例患者发生HCC（7.2%；7例为HCC新发，12例为HCC复发）。多因素Cox回归分析显示，HCC病史（风险比[HR]：10.634；95%置信区间[CI]：4.13 - 27.37；P = 0.001）、年龄较大（HR：4.638；95% CI：1.63 - 13.61；P = 0.004）和总胆红素水平较高（HR：4.189；95% CI：1.66 - 10.60；P = 0.002）是HCC发生的独立预测因素，基线时较高的LS值（≥1.73 m/s）是HCC新发的独立预测因素（HR：8.350；95% CI：1.62 - 43.09；P = 0.011）。既往接受过HCC治疗的患者中，HCC的累积复发率根据LS程度在统计学上相似。
基线LS值有助于预测HCC的发生。因此，即使实现了SVR，基线LS值较高的患者也必须密切随访HCC的发生情况。
