Aspartate aminotransferase to platelet ratio index and sustained virologic response are associated with progression from hepatitis C associated liver cirrhosis to hepatocellular carcinoma after treatment with pegylated interferon plus ribavirin

Abstract

Background

The aim of this study was to evaluate the clinically significant predictors of hepatocellular carcinoma (HCC) development among hepatitis C virus (HCV) cirrhotic patients receiving combination therapy.

Patients and methods

One hundred and five compensated cirrhosis patients who received pegylated interferon plus ribavirin between January 2005 and December 2011 were enrolled. All the patients were examined with abdominal sonography and liver biochemistry at baseline, end of treatment, and every 3–6 months posttreatment. The occurrence of HCC was evaluated every 3–6 months posttreatment.

Results

A total of 105 patients were enrolled (mean age 58.3±10.4 years). The average follow-up time for each patient was 4.38 years (standard deviation 1.73 years; range 1.13–9.27 years). Fifteen (14.3%) patients developed HCC during follow-up period. Thirteen of them had high baseline aspartate aminotransferase to platelet ratio index (APRI) (ie, an APRI >2.0). Multivariate analysis showed that those without sustained virologic response (SVR) (hazard ratio [HR] 5.795; 95% confidence interval [CI] 1.370–24.5; P=0.017) and high APRI (HR 5.548; 95% CI 1.191–25.86; P=0.029) had a significantly higher risk of HCC occurrence. The cumulative incidence of HCC was significantly higher (P=0.009) in patients without SVR (3-year cumulative incidence 21.4%; 95% CI 7.4%–35.5%; 5-year cumulative incidence 31.1%; 95% CI 11.2%–51.1%) compared to those with SVR (3- and 5-year cumulative incidence 6.2%; 95% CI 0%–1.3%). Further, the cumulative incidence of HCC was significantly higher (P=0.006) in patients with high APRI (3-year cumulative incidence 21.8%; 95% CI 8.2%–35.3%; 5-year cumulative incidence 30.5%, 95% CI 11.8%–49.3%) compared to those with low APRI (3- and 5-year cumulative incidence 4.2%, 95% CI 0%–1.0%).

Conclusion

In HCV-infected cirrhotic patients who received combination therapy, APRI and SVR are the two major predictors of HCC development.

Keywords:

• aspartate aminotransferase to platelet ratio index
• chronic hepatitis C
• hepatitis C virus
• hepatocellular carcinoma
• liver cirrhosis
• sustained virologic response

Acknowledgments

We would like to thank the nursing departments of Dalin Tzu Chi Hospital for their assistance in procuring records. The study was funded by Dalin Tzu Chi General Hospital (DTCRD99(2)-E-13).

Author contributions

Khai-Jing Ng: drafting of the manuscript; Chih-Wei Tseng: statistical analysis, material support, and drafting of the manuscript; Ting-Tsung Chang and Shu-Fen Wu: critical revision of the manuscript for important intellectual content; Shinn-Jia Tzeng: statistical analysis; Yu-Hsi Hsieh, Tsung-Hsing Hung, and Hsiang-Ting Huang: material support; Kuo-Chih Tseng: material support and critical revision of the manuscript for important intellectual content. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work. The abstract of this paper was presented at the Asian Pacific Digestive Week, Taipei, Taiwan, 3–6 December, 2015. The abstract was published in “Poster Abstracts” in the Journal of Gastroenterology and Hepatology, special issue: Volume 30, Issue Supplement S4, December 2015.