A validation study of after direct‐acting antivirals recommendation for surveillance score for the development of hepatocellular carcinoma in patients with hepatitis C virus infection who had received direct‐acting antiviral therapy and achieved sustained virological response
Toshifumi Tada,
Masayuki Kurosaki,
Nobuharu Tamaki,
Yutaka Yasui,
Nami Mori,
Keiji Tsuji,
Chitomi Hasebe,
Koji Joko,
Takehiro Akahane,
Koichiro Furuta,
Haruhiko Kobashi,
Hiroyuki Kimura,
Hitoshi Yagisawa,
Hiroyuki Marusawa,
Masahiko Kondo,
Yuji Kojima,
Hideo Yoshida,
Yasushi Uchida,
Shinichiro Nakamura,
Namiki Izumi
Affiliations
Toshifumi Tada
Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
Masayuki Kurosaki
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Nobuharu Tamaki
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Yutaka Yasui
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Nami Mori
Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic‐Bomb Survivors Hospital Hiroshima Hiroshima Japan
Keiji Tsuji
Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic‐Bomb Survivors Hospital Hiroshima Hiroshima Japan
Chitomi Hasebe
Department of Gastroenterology Japanese Red Cross Asahikawa Hospital Asahikawa Hokkaido Japan
Koji Joko
Center for Liver‐Biliary‐Pancreatic Disease Matsuyama Red Cross Hospital Matsuyama Ehime Japan
Takehiro Akahane
Department of Gastroenterology Japanese Red Cross Ishinomaki Hospital Ishinomaki Miyagi Japan
Koichiro Furuta
Department of Gastroenterology Masuda Red Cross Hospital Masuda Shimane Japan
Haruhiko Kobashi
Department of Gastroenterology Japanese Red Cross Okayama Hospital Okayama Okayama Japan
Hiroyuki Kimura
Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Kyoto Japan
Hitoshi Yagisawa
Department of Gastroenterology Japanese Red Cross Akita Hospital Akita Akita Japan
Hiroyuki Marusawa
Department of Gastroenterology and Hepatology Japanese Red Cross Osaka Hospital Osaka Japan
Masahiko Kondo
Department of Gastroenterology Japanese Red Cross Otsu Hospital Otsu Shiga Japan
Yuji Kojima
Department of Hepatology Japanese Red Cross Ise Hospital Ise Mie Japan
Hideo Yoshida
Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan
Yasushi Uchida
Department of Gastroenterology Japanese Red Cross Matsue Hospital Matsue Shimane Japan
Shinichiro Nakamura
Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
Namiki Izumi
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Abstract Background and Aim The pathogenic process underlying the development of hepatocellular carcinoma (HCC) is not yet clear in patients with hepatitis C virus (HCV) who have received direct‐acting antiviral (DAA) therapy and achieved sustained virological response (SVR). This study validated a composite predictive model for HCC in these patients. Methods This study included 3058 patients in whom HCV was eradicated with DAA therapy. After DAAs recommendation for surveillance (ADRES) score, which is based on sex, FIB‐4 index, and α‐fetoprotein, was used as a composite predictive model for HCC development. Results The 1‐, 3‐, and 5‐year cumulative incidence rates of HCC were 0.9, 4.5, and 15.2%, respectively. Multivariate analysis with Cox proportional hazards models showed that male sex (hazard ratio [HR], 2.646; 95% confidence interval [CI], 1.790–3.911), FIB‐4 index >3.25 (HR, 2.891; 95% CI, 1.947–4.293), and α‐fetoprotein >5 ng/mL (HR, 2.835; 95% CI, 1.914–4.200) are independently associated with HCC development. The incidence of HCC differed significantly by ADRES score (P < 0.001). Cox proportional hazards models showed that compared to the ADRES score 0 group, the HR for HCC development was 2.947 (95% CI, 1.367–6.354) in the ADRES score 1 group, 9.171 (95% CI, 4.339–19.380) in the ADRES score 2 group, and 20.630 (95% CI, 8.641–49.230) in the ADRES score 3 group. ADRES score had superior predictive power for HCC development compared with the FIB‐4 index and α‐fetoprotein according to time‐dependent receiver operating characteristic analysis. Conclusion The ADRES score is useful for predicting HCC development after SVR.
