Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2017; 23(44): 7863-7874
Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7863
Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis
Ka-Shing Cheung, Wai-Kay Seto, James Fung, Lung-Yi Mak, Ching-Lung Lai, Man-Fung Yuen
Ka-Shing Cheung, Wai-Kay Seto, James Fung, Lung-Yi Mak, Ching-Lung Lai, Man-Fung Yuen, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Wai-Kay Seto, James Fung, Ching-Lung Lai, Man-Fung Yuen, State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Cheung KS designed and performed the study, were involved in statistical analysis and interpretation of the data, and wrote the manuscript; Seto WK and Mak LY performed the study, statistical analysis and interpretation of the data; Fung J, Lai CL and Yuen MF revised and edited the manuscript.
Institutional review board statement: This study was approved by The Institutional Review Board of The University of Hong Kong/Hospital Authority, Hong Kong West Cluster.
Informed consent statement: The Institutional Review Board of The University of Hong Kong/Hospital Authority waived the need for written informed consent as there was no direct contact with eligible subjects and no additional blood taking.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Man-Fung Yuen, Professor, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China. mfyuen@hkucc.hku.hk
Telephone: +852-22553984 Fax: +852-28162863
Received: July 28, 2017
Peer-review started: July 28, 2017
First decision: August 30, 2017
Revised: September 25, 2017
Accepted: September 28, 2017
Article in press: September 28, 2017
Published online: November 28, 2017
Abstract
AIM

To investigate the usefulness of aspartate aminotransferase to platelet ratio index (APRI) in predicting hepatocellular carcinoma (HCC) risk in primary biliary cholangitis (PBC).

METHODS

We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio (HR) of HCC with different risk factors was determined by Cox proportional hazards model.

RESULTS

One hundred and forty-four PBC patients were recruited. Patients were diagnosed at a median age of 57.8 years [interquartile range (IQR): 48.7-71.5 years), and 41 (28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years (range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10- and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4% (95%CI: 1.8%-14.5%) and 21.6% (6.8%-34.1%), respectively. Older age (HR = 1.07), cirrhosis (HR = 4.38) and APRI at 1 year after treatment (APRI-r1) > 0.54 (HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk (log rank P < 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77 (95%CI: 0.64-0.88).

CONCLUSION

APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.

Keywords: Aspartate aminotransferase, Platelet ratio index, Hepatocellular carcinoma, Primary biliary cholangitis, Ursodeoxycholic acid, Cirrhosis

Core tip: Currently, no reliable predictive models exist for hepatocellular carcinoma (HCC) in primary biliary cholangitis (PBC). Our study showed that a higher aspartate aminotransferase to platelet ratio index (APRI) at 1 year after treatment (APRI-r1) was associated with a higher HCC risk. The performance of APRI-r1 in predicting HCC was satisfactory (area under the receiver operating curve: 0.77). Combination of APRI-r1 with treatment response further stratified HCC risk. Owing to its simplicity, non-invasiveness and cost-effectiveness, APRI can be used as a marker to streamline the HCC surveillance protocol in PBC patients.