Liver and Bile
J Viral Hepat. 2022;29(1):35–42
Serum alpha-fetoprotein level at treatment completion is a useful predictor of hepatocellular carcinoma occurrence more than 1 year after hepatitis C virus eradication by direct-acting antiviral treatment
Direct-acting antivirals (DAAs) have recently been developed to treat hepatitis C virus (HCV) infection, and interferon-free DAA treatment has improved liver function of HCV patients. The risk of hepatocellular carcinoma (HCC) occurrence following HCV eradication has been previously reported, but HCC may have been missed following imaging diagnosis before DAA administration in previous studies. Therefore, the present study aimed to identify definite predictors of HCC occurrence ≥ 1 year after DAA treatment. Among 956 patients receiving DAAs for HCV infection, 567 patients who achieved sustained virological response with no history of HCC treatment were enrolled in this study between September 2014 and July 2021. The incidence of HCC in HCV-infected patients ≥ 1 year following DAA treatment, and the predictors contributing to HCC occurrence were identified using clinical characteristics and blood test results. In the present study, 25 patients developed HCC. The incidence of HCC was 1.4%, 3.2%, 4.9%, and 6.8% at 2, 3, 4, and 5 years, respectively, from the end of treatment with DAAs. Multivariate logistic analysis revealed serum alpha-fetoprotein at end of treatment (EOT-AFP) level > 3.8 ng/ml ≥ 1 year following treatment with DAAs (hazard ratio = 9.7, p < 0.0001) as an independent factor that may contribute to HCC occurrence following DAA treatment.
In conclusion, serum alpha-fetoprotein at end of treatment (EOT-AFP) level may serve an important role in determining the risk of hepatocellular carcinoma occurrence ≥ 1 year after treatment with direct-acting antivirals. Regular examinations are required even if serum EOT-AFP level is low at treatment completion.