Department of Gastroenterology and Hepatology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Nov;26(22):8459-8466. doi: 10.26355/eurrev_202211_30400.
The continued risk of hepatocellular cancer (HCC) following HCV clearance by direct-acting antivirals (DAAs), even if a sustained viral response (SVR) is achieved, has been previously reported. This study's objective was to identify biochemical predictors for HCC occurrence in patients who achieved HCV clearance by DAA treatment after one year.
Patients who achieved SVR at week 24 with DAA between November 2015 and January 2021 and had no evidence of HCC were evaluated retrospectively. Biochemical parameters such as serum AFP (Alpha-fetoprotein), AST (Aspartate Aminotransferase), ALT (Alanine aminotransferase), albumin, PLT (platelet) count, FIB-4 and APRI indexes (non-invasive fibrosis indexes) were analyzed before starting the DAA treatment, at the end of the treatment (EOT), and 24th-week post-treatment.
Throughout a median follow-up time of 43±16.2 months, it was observed that HCC occurred in 14 (5.6%) of 248 CHC patients who reached SVR at the 24th week after DAA treatment. According to multivariate analysis, AFP levels were >7.08 ng/ml before treatment (HR, 3.8; p=0.050), >5.15 ng/ml at the EOT (HR, 6.8; p=0.019), and >5.68 ng/ml at the 24th week post-treatment (HR, 21.2; p=0.002); albumin levels were <3.75 g/dl before treatment (HR, 3.6; p=0.042), <4.05 g/dl at the EOT (HR, 6.9; p=0.005), and <4.15 g/dl at week 24 post-treatment (HR, 8.8; p=0.002); PLT counts <153.000/mm3 at the 24th week post-treatment (HR, 12.1; p=0.001) were determined to be independent biochemical predictors for the development of HCC after one year of ending DAA treatment.
AFP and albumin levels before treatment, at the EOT, and post-treatment at week 24, and PLT numbers at week 24 post-treatment can be used to foresee the risk of developing HCC one year after ending of DAA treatment.
已报道，即使获得持续病毒学应答（SVR），直接作用抗病毒药物（DAA）清除 HCV 后仍存在肝细胞癌（HCC）持续发生的风险。本研究旨在确定 DAA 治疗后 1 年获得 HCV 清除的患者中 HCC 发生的生化预测因子。
回顾性评估了 2015 年 11 月至 2021 年 1 月间接受 DAA 治疗并在第 24 周时获得 SVR 且无 HCC 证据的患者。分析了开始 DAA 治疗前、治疗结束时（EOT）和治疗后 24 周时的血清 AFP（甲胎蛋白）、AST（天冬氨酸转氨酶）、ALT（丙氨酸转氨酶）、白蛋白、PLT（血小板）计数、FIB-4 和 APRI 指数（非侵入性纤维化指数）等生化参数。
在中位随访时间 43±16.2 个月期间，观察到 248 例接受 DAA 治疗后第 24 周达到 SVR 的 CHC 患者中有 14 例（5.6%）发生 HCC。多变量分析显示，治疗前 AFP 水平＞7.08ng/ml（HR，3.8；p=0.050）、EOT 时＞5.15ng/ml（HR，6.8；p=0.019）和治疗后 24 周时＞5.68ng/ml（HR，21.2；p=0.002）；治疗前白蛋白水平＜3.75g/dl（HR，3.6；p=0.042）、EOT 时＜4.05g/dl（HR，6.9；p=0.005）和治疗后 24 周时＜4.15g/dl（HR，8.8；p=0.002）；治疗后 24 周时 PLT 计数＜153.000/mm3（HR，12.1；p=0.001）被确定为 DAA 治疗结束后 1 年 HCC 发生的独立生化预测因子。
治疗前、EOT 时和治疗后 24 周时的 AFP 和白蛋白水平以及治疗后 24 周时的 PLT 计数可用于预测 DAA 治疗结束后 1 年 HCC 的发生风险。
