Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2023; 11(22): 5204-5214
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5204
Combining the age-male-albumin-bilirubin-platelets score and shear wave elastography stratifies carcinogenic risk in hepatitis C patients after viral clearance
Rion Masaoka, Yoshinori Gyotoku, Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano
Rion Masaoka, Yoshinori Gyotoku, Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya 343-8555, Saitama, Japan
Author contributions: Masaoka R, Gyotoku Y, and Shirahashi R conceptualized and designed the study, collected data, carried out the initial analysis, and drafted the initial manuscript; Suda T and Tamano M coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content; All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Institutional review board statement: This study was approved by the ethics committee of the Dokkyo Medical University Saitama Medical Center (Approval No. 22105).
Informed consent statement: Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient gave informed consent to treatment. For full disclosure, the details of this retrospective, observational study were published on the home page of the medical center.
Conflict-of-interest statement: Rion Masaoka, Yoshinori Gyotoku, Ryosaku Shirahasi, Toshikuni Suda, and MasayaTamano have no financial relationships relevant of this article to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masaya Tamano, PhD, Professor, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya 343-8555, Saitama, Japan. mstamano@dokkyomed.ac.jp
Received: May 10, 2023
Peer-review started: May 10, 2023
First decision: June 20, 2023
Revised: June 23, 2023
Accepted: July 7, 2023
Article in press: July 7, 2023
Published online: August 6, 2023
Abstract
BACKGROUND

The treatment of hepatitis C with direct-acting antiviral agents (DAAs) produces a high rate of sustained virological response (SVR) with fewer adverse events than interferon (IFN) therapy with a similar effect in inhibiting carcinogenesis as IFN therapy. The age-male-albumin-bilirubin-platelets (aMAP) score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients, and the velocity of shear waves (Vs) measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk. Combining these two may improve the prediction of carcinogenic risk.

AIM

To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.

METHODS

This retrospective, observational study involved hepatitis C patients treated with DAAs who achieved SVR. Vs was measured before treatment (baseline), at the end of treatment (EOT), and 12 wk (follow-up 12) and 24 wk (follow-up 24) after treatment. The patients were followed for at least six months after EOT to determine whether cancer developed. Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis. The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic (ROC) curve analyses.

RESULTS

A total of 279 patients (mean age 65.9 years, 118 males, 161 females) were included in the analysis. Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase, platelets, α-fetoprotein, Vs, and the Fib-4 index as explanatory variables; only Vs was found to be significant (P = 0.0296). The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s. Carcinoma developed in 2.0% (3/151) of those with Vs < 1.53 m/s and in 10.5% (9/86) of those with Vs ≥ 1.53 m/s.

CONCLUSION

In hepatitis C patients after SVR, combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.

Keywords: Hepatitis C, Hepatocellular carcinoma, Direct-acting antiviral therapy, Shear wave elastography, Sustained virological response, Age-male-albumin-bilirubin-platelets score

Core Tip: Predicting the risk of carcinogenesis is important in hepatitis C patients who achieve sustained virological response (SVR) following direct-acting antiviral therapy. Both the age-male-albumin-bilirubin-platelets (aMAP) score and the velocity of shear waves (Vs) measured by SWE have been shown to be useful for stratifying the risk of hepatocellular carcinoma (HCC) in such patients. This study demonstrated that, for hepatitis C patients after SVR at medium and high risk for HCC, combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.