Lin Cheng-Kuan, Wang Ssu-Han, Lee Tzong-Hsi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nanya South Road, Section 2, Banqiao District, New Taipei City, 220216, Taiwan.
Sci Rep. 2025 Sep 2;15(1):32312. doi: 10.1038/s41598-025-14861-9.
The elevation of serum alpha-fetoprotein (AFP) is frequently observed in patients with chronic hepatitis C (CHC). In most cases, the level decreased after antiviral treatment. This study investigated the relationship between post-treatment AFP normalization and the risk of hepatocellular carcinoma (HCC) in CHC patients without baseline HCC. A total of 483 patients treated with sofosbuvir-based direct-acting antivirals (DAAs) were enrolled and followed for a mean duration of 38.8 months. The mean age was 59.6 years, and 27.1% of patients had liver cirrhosis. The sustained virological response (SVR) rate was 98.6%. The pre-treatment AFP levels > 7 ng/mL, > 10 ng/mL, and > 15 ng/mL were observed in 25.4%, 18.8%, and 9.7% of patients, respectively. By 12 weeks post-treatment, 86.2% of patients had AFP levels < 7 ng/mL. During follow-up, 5.4% of patients developed HCC. The independent risk factors for HCC included age ≥ 65 years, liver cirrhosis, and post-treatment AFP > 7 ng/mL. The hazard ratio of HCC was 0.03 (95% CI: 0.01-0.3, P < 0.01) in the "Normalization" group, compared to the "Persistent elevation" group. The hazard ratio was 0.28 (95% CI: 0.1-0.73, P = 0.01) in the "Stable normal" group, compared to the "Elevation" group. The findings suggest that normalization of AFP levels or stable normal levels after treatment are associated with a reduced risk of HCC.
慢性丙型肝炎（CHC）患者血清甲胎蛋白（AFP）升高的情况较为常见。在大多数情况下，抗病毒治疗后该水平会下降。本研究调查了基线时无肝细胞癌（HCC）的CHC患者治疗后AFP恢复正常与HCC风险之间的关系。共纳入483例接受基于索磷布韦的直接抗病毒药物（DAA）治疗的患者，并进行了平均38.8个月的随访。平均年龄为59.6岁，27.1%的患者患有肝硬化。持续病毒学应答（SVR）率为98.6%。分别有25.4%、18.8%和9.7%的患者治疗前AFP水平>7 ng/mL、>10 ng/mL和>15 ng/mL。治疗后12周时，86.2%的患者AFP水平<7 ng/mL。随访期间，5.4%的患者发生了HCC。HCC的独立危险因素包括年龄≥65岁、肝硬化以及治疗后AFP>7 ng/mL。与“持续升高”组相比，“恢复正常”组HCC的风险比为0.03（95%CI：0.01 - 0.3，P<0.01）。与“A FP升高”组相比，“稳定正常”组HCC的风险比为0.28（95%CI：0.1 - 0.73，P = 0.01）。研究结果表明，治疗后AFP水平恢复正常或保持稳定正常水平与HCC风险降低相关。
