Prediction of Hepatocellular Carcinoma Development in Korean Patients after Hepatitis C Cure with Direct-Acting Antivirals
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Background/Aims: With the wide application of direct-acting antivirals (DAAs) for hepatitis C virus infection, the number of patients achieving a sustained virologic response (SVR) will continue to increase. However, no consensus has been achieved on exempting SVR-achieving patients from hepatocellular carcinoma (HCC) surveillance. Methods: Between 2013 and 2021, 873 Korean patients who achieved SVR following DAA treatment were analyzed. We evaluated the predictive performance of seven noninvasive scores (PAGE-B, modified PAGE-B, Toronto HCC risk index, fibrosis-4, aspartate aminotransferase-to-platelet ratio index, albumin-bilirubin, and age male albumin-bilirubin platelet [aMAP]) at baseline and after SVR. Results: The mean age of the 873 patients (39.3% males) was 59.1 years, and 224 patients (25.7%) had cirrhosis. During 3,542 person-years of follow-up, 44 patients developed HCC, with an annual incidence of 1.24/100 person-years. Male sex (adjusted hazard ratio [AHR], 2.21), cirrhosis (AHR, 7.93), and older age (AHR, 1.05) were associated with a significantly higher HCC risk in multivariate analysis. The performance of all scores at the time of SVR were numerically better than those at baseline as determined by the integrated area under the curve. Time-dependent area under the curves for predicting the 3-, 5-, and 7-year risk of HCC after SVR were higher in mPAGE-B (0.778, 0.746, and 0.812, respectively) and aMAP (0.776, 0.747, and 0.790, respectively) systems than others. No patients predicted as low-risk by the aMAP or mPAGE-B systems developed HCC. Conclusions: aMAP and mPAGE-B scores demonstrated the highest predictive performance for de novo HCC in DAA-treated, SVR-achieving patients. Hence, these two systems may be used to identify low-risk patients that can be exempted from HCC surveillance.
Abstract
Background/Aims: With the wide application of direct-acting antivirals (DAAs) for hepatitis C virus infection, the number of patients achieving a sustained virologic response (SVR) will continue to increase. However, no consensus has been achieved on exempting SVR-achieving patients from hepatocellular carcinoma (HCC) surveillance. Methods: Between 2013 and 2021, 873 Korean patients who achieved SVR following DAA treatment were analyzed. We evaluated the predictive performance of seven noninvasive scores (PAGE-B, modified PAGE-B, Toronto HCC risk index, fibrosis-4, aspartate aminotransferase-to-platelet ratio index, albumin-bilirubin, and age male albumin-bilirubin platelet [aMAP]) at baseline and after SVR. Results: The mean age of the 873 patients (39.3% males) was 59.1 years, and 224 patients (25.7%) had cirrhosis. During 3,542 person-years of follow-up, 44 patients developed HCC, with an annual incidence of 1.24/100 person-years. Male sex (adjusted hazard ratio [AHR], 2.21), cirrhosis (AHR, 7.93), and older age (AHR, 1.05) were associated with a significantly higher HCC risk in multivariate analysis. The performance of all scores at the time of SVR were numerically better than those at baseline as determined by the integrated area under the curve. Time-dependent area under the curves for predicting the 3-, 5-, and 7-year risk of HCC after SVR were higher in mPAGE-B (0.778, 0.746, and 0.812, respectively) and aMAP (0.776, 0.747, and 0.790, respectively) systems than others. No patients predicted as low-risk by the aMAP or mPAGE-B systems developed HCC. Conclusions: aMAP and mPAGE-B scores demonstrated the highest predictive performance for de novo HCC in DAA-treated, SVR-achieving patients. Hence, these two systems may be used to identify low-risk patients that can be exempted from HCC surveillance.
참고문헌 (27)
- Axley P, "Hepatitis C virus and hepatocellular carcinoma : a narrative review", J Clin Transl Hepatol, 6, pp.79~84 (2018)
- Park YJ, "Real-life effectiveness and safety of glecaprevir", pibrentasvir for Korean patients with chronic hepatitis C at a single institution, 2021, pp.15, 440~450
- Heo J, "Efficacy and safety of glecaprevir", pibrentasvir in Korean patients with chronic hepatitis C : a pooled analysis of five phase II, Gut Liver, pp.2021, 15[DOI]
- Semmler G, "HCC risk stratification after cure of hepatitis C in patients with compensated advanced chronic liver disease", J Hepatol, 76, pp.812~821 (2022)
- D’Ambrosio R, "Incidence of liver-and non-liver-related outcomes in patients with HCVcirrhosis after SVR", J Hepatol, 76, pp.302~310 (2022)
- Ahn YH, "Independent risk factors for hepatocellular carcinoma recurrence after direct-acting antiviral therapy in patients with chronic hepatitis C", Gut Liver, 15, pp.410~419 (2021)
- European Association for the Study of the Liver, "EASL clinical practice guidelines : management of hepatocellular carcinoma", J Hepatol, 69, pp.182~236 (2018)
- Marrero JA, "Diagnosis, staging, and management of hepatocellular carcinoma : 2018 practice guidance by the American Association for the Study of Liver Diseases", Hepatology, 68, pp.723~750 (2018)
- Kanda T, "APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation", Hepatol Int, 13, pp.649~661 (2019)
- Luna-Cuadros MA, "Risk of hepatocellular carcinoma after hepatitis C virus cure", World J Gastroenterol, 28, pp.96~107 (2022)
- Yamashita Y, "aMAP score prediction of hepatocellular carcinoma occurrence and incidencefree rate after a sustained virologic response in chronic hepatitis C", Hepatol Res, 51, pp.933~942 (2021)
- Omata M, "Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma : a 2017 update", Hepatol Int, 11, pp.317~370 (2017)
- Korean Liver Cancer Association, "2018 Korean Liver Cancer Association-National Cancer Center Korea practice guidelines for the management of hepatocellular carcinoma", Gut Liver, 13, pp.227~299 (2019)
- Papatheodoridis G, "PAGE-B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5-year antiviral therapy", J Hepatol, 64, pp.800~806 (2016)
- Sharma SA, "Toronto HCC risk index : a validated scoring system to predict 10-year risk of HCC in patients with cirrhosis", J Hepatol, 68, pp.92~99 (2018)
- Lin ZH, "Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis : an updated meta-analysis", Hepatology, 53, pp.726~736 (2011)
- Sterling RK, "Development of a simple noninvasive index to predict significant fibrosis in patients with HIV", HCV coinfection, 2006, pp.43, 1317~1325
- Fan R, "aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis", J Hepatol, 73, pp.1368~1378 (2020)
- Kim JH, "Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy", J Hepatol, 69, pp.1066~1073 (2018)
- Johnson PJ, "Assessment of liver function in patients with hepatocellular carcinoma : a new evidence-based approach-the ALBI grade", J Clin Oncol, 33, pp.550~558 (2015)
- Harrell FE, "Regression models for prognostic prediction : advantages, problems, and suggested solutions", Cancer Treat Rep, 69, pp.1071~1077 (1985)
- Heagerty PJ, "Survival model predictive accuracy and ROC curves", Biometrics, 61, pp.92~105 (2005)
- Ioannou GN, "HCC surveillance after SVR in patients with F3", F4 fibrosis, 2021, pp.74, 458~465
- Caviglia GP, "Long-term hepatocellular carcinoma development and predictive ability of non-invasive scoring systems in patients with HCV-related cirrhosis treated with direct-acting antivirals", Cancers(Basel), 14, pp.828~ (2022)
- Tamaki N, "Change in fibrosis 4index as predictor of high risk of incident hepatocellular carcinoma after eradication of hepatitis C virus", Clin Infect Dis, 73, pp.e3349~e3354 (2021)
- Alonso López S, "A model based on noninvasive markers predicts very low hepatocellular carcinoma risk after viral response in hepatitis C virusadvanced fibrosis", Hepatology, 72, pp.1924~1934 (2020)
- Lee HW, "Predicting liver-related events using transient elastography in chronic hepatitis C patients with sustained virological response", Gut Liver, 10, pp.429~436 (2016)