Alpha-fetoprotein and des-gamma-carboxy-prothrombin at twenty-four weeks after interferon-based therapy predict hepatocellular carcinoma development

doi:10.4254/wjh.v7.i27.2757

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Nov 28, 2015; 7(27): 2757-2764
Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2757

Table 1 Pretreatment clinical characteristics of 231 hepatitis C virus-related liver cirrhosis patients treated with interferon and ribavirin

	All patients (n = 231)	Non HCC (n = 181)	HCC (n = 50)	P-value¹
Sex (M:F)	111:120	82:99	29:21	NS
Age (yr)	60.4 ± 9.2	59.6 ± 9.2	63.1 ± 9.1	0.018
BMI (kg/m²)	23.7 ± 3.4	23.7 ± 3.5	23.9 ± 2.9	NS
Total bilirubin (mg/dL)	1.1 ± 1.2	1.2 ± 1.4	0.9 ± 0.3	NS
Albumin (g/dL)	3.8 ± 0.5	3.8 ± 0.5	3.8 ± 0.3	NS
Prothrombin (%)	86.1 ± 15.2	86.1 ± 15.8	86.1 ± 13.2	NS
ALT (IU/L)	84.6 ± 64.4	86.6 ± 65.8	77.1 ± 59.6	NS
GGT (IU/L)	89.0 ± 124.0	89.0 ± 125.2	89.3 ± 122.1	NS
Hemoglobin (g/dL)	13.2 ± 1.8	13.1 ± 1.9	13.5 ± 1.7	NS
Platelets (10⁴/mm³)	12.1 ± 6.8	12.2 ± 7.2	11.7 ± 5.1	NS
AFP (ng/mL)	94.1 ± 916.1	24.2 ± 38.0	355.1 ± 1994.9	0.038
DCP (mAU/mL)	261.5 ± 2687.8	328.6 ± 3057.3	26.5 ± 18.1	NS
IL28B (TT:non TT)	161:70	130:51	31:19	NS
Presence of EV	74/191 (38.7%)	60/146 (41.1%)	14/45 (31.1%)	NS
HCC treatment history	80 (34.6%)	44 (24.3%)	36 (72.0%)	NS
HCV genotype (1/2)	189:42	147:34	42:8	NS
IFN treatment (naive)	208 (90.0%)	162 (89.5%)	46 (92%)	NS

Data are expressed as number (%) or mean ± SD. All demographic and clinical data are those at the start of antiviral treatment.

¹Comparison between non HCC and HCC. HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; NS: Not significant; BMI: Body mass index; ALT: Alanine aminotransferase; GGT: Gamma glutamyl transpeptidase; AFP: Alpha-fetoprotein; DCP: Des-gamma-carboxy prothrombin; IL28B: Interleukin 28B rs8099917; EV: Esophageal varices; IFN: Interferon.

Table 2 Risk factors for the development of hepatocellular carcinoma in hepatitis C virus-related liver cirrhosis patients treated with interferon and ribavirin

	Non HCC (n = 181)	HCC (n = 50)	P-value
IFN treatment duration (wk)	43.1 ± 21.5	44.1 ± 22.5	NS
Sustained virological response	63 (34.8%)	12 (24%)	NS
Albumin levels at the end of IFN treatment (g/dL)	3.7 ± 0.6	3.7 ± 0.6	NS
Prothrombin levels at the end of IFN treatment (%)	86.0 ± 21.5	83.5 ± 11.1	NS
AFP levels at the end of IFN treatment (ng/mL)	15.5 ± 34.9	42.8 ± 96.0	0.009
DCP levels at the end of IFN treatment (mAU/mL)	25.6 ± 47.2	255.6 ± 863.2	0.017
Albumin levels at 24 wk after IFN treatment (g/dL)	4.0 ± 0.5	3.7 ± 0.5	0.004
Prothrombin levels at 24 wk after IFN treatment (%)	87.8 ± 17.9	86.6 ± 14.2	NS
AFP levels at 24 wk after IFN treatment (ng/mL)	11.5 ± 15.8	63.2 ± 193.2	0.002
DCP levels at 24 wk after IFN treatment (mAU/mL)	18.4 ± 12.7	354.0 ± 1887.5	NS

Data are expressed as number (%) or mean ± SD. HCC: Hepatocellular carcinoma; IFN: Interferon; NS: Not significant; AFP: Alpha-fetoprotein; DCP: Des-gamma-carboxy prothrombin.

Table 3 The levels of alpha-fetoprotein and des-gamma-carboxy prothrombin with development of hepatocellular carcinoma in patients with sustained virological response

	Patients with SVR (n = 75)	Non HCC (n = 63)	HCC (n = 12)	P-value¹
AFP levels at pretreatment (ng/mL)	16.1 ± 20.2	17.8 ± 22.2	12.6 ± 14.9	NS
AFP levels at the end of IFN treatment (ng/mL)	13.7 ± 47.8	17.9 ± 57.8	5.1 ± 1.8	NS
AFP levels at 24 wk after IFN treatment (ng/mL)	6.7 ± 10.0	5.8 ± 4.1	8.0 ± 15.1	NS
Pre DCP levels at pretreatment (mAU/mL)	93.7 ± 374.1	131.3 ± 481.4	40.3 ± 69.8	NS
Post DCP levels at the end of IFN treatment (mAU/mL)	140.0 ± 637.9	226.9 ± 864.2	42.1 ± 83.3	NS
24 wk DCP levels at 24 wk after IFN treatment (mAU/mL)	33.9 ± 52.6	28.9 ± 37.4	39.3 ± 66.5	NS

Data are expressed as number (%) or mean ± SD.

¹Comparison between non HCC and HCC. HCC: Hepatocellular carcinoma; AFP: Alpha-fetoprotein; DCP: Des-gamma-carboxy prothrombin; NS: Not significant; SVR: Sustained virological response.

Table 4 Factors associated with hepatocellular carcinoma development (n = 231)

Risk factor	Univariate analysis	Multivariate analysis	OR	95%CI
	P-value	P-value
Age (over 60 yr)	0.012	Not significant
HCC treatment history	< 0.001	< 0.001	15.27	4.98-59.51
AFP levels at 24 wk after IFN treatment ≥ 10 ng/mL	0.003	0.009	3.89	1.38-11.94
DCP levels at 24 wk after IFN treatment ≥ 40 mAU/mL	< 0.001	< 0.001	24.43	4.11-238.67

HCC: Hepatocellular carcinoma; AFP: Alpha-fetoprotein; IFN: Interferon; DCP: Des-gamma-carboxy prothrombin.

Citation: Shakado S, Sakisaka S, Chayama K, Okanoue T, Toyoda J, Izumi N, Matsumoto A, Takehara T, Ido A, Hiasa Y, Yoshioka K, Nomura H, Ueno Y, Seike M, Kumada H. Alpha-fetoprotein and des-gamma-carboxy-prothrombin at twenty-four weeks after interferon-based therapy predict hepatocellular carcinoma development. World J Hepatol 2015; 7(27): 2757-2764
URL: https://www.wjgnet.com/1948-5182/full/v7/i27/2757.htm
DOI: https://dx.doi.org/10.4254/wjh.v7.i27.2757