Published online Sep 8, 2015. doi: 10.4254/wjh.v7.i19.2220
Peer-review started: March 22, 2015
First decision: April 27, 2015
Revised: June 20, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: September 8, 2015
AIM: To investigate factors that accurately predict hepatocellular carcinoma (HCC) development after antiviral therapy in chronic hepatitis C (CHC) patients.
METHODS: CHC patients who received pegylated interferon and ribavirin were enrolled in this cohort study that investigated the ability of alpha-fetoprotein (AFP) to predict HCC development after interferon (IFN) therapy.
RESULTS: Of 1255 patients enrolled, 665 developed sustained virological response (SVR) during mean follow-up period of 5.4 years. HCC was occurred in 89 patients, and 20 SVR patients were included. Proportional hazard models showed that HCC occurred in SVR patients showing AFP ≥ 5 ng/mL before therapy and in non-SVR patients showing AFP ≥ 5 ng/mL before and 1 year after therapy besides older age, and low platelet counts. SVR patients showing AFP ≥ 5 ng/mL before therapy and no decrease in AFP to < 5 ng/mL 1 year after therapy had significantly higher HCC incidence than non-SVR patients showing AFP ≥ 5 ng/mL before therapy and decreased AFP (P = 0.043). AFP ≥ 5 ng/mL before therapy was significantly associated with low platelet counts and high values of alanine aminotransferase (ALT) in stepwise logistic regression analysis. After age, gender, platelet count, and ALT was matched by propensity score, significantly lower HCC incidence was shown in SVR patients showing AFP < 5 ng/mL before therapy than in those showing AFP ≥ 5 ng/mL.
CONCLUSION: The criteria of AFP < 5 ng/mL before and 1 year after IFN therapy is a benefical predictor for HCC development in CHC patients.
Core tip: What is current knowledge: (1) Alpha-fetoprotein (AFP) values can predict development of hepatocellular carcinoma (HCC) after interferon therapy in patients with hepatitis C virus; and (2) The predictive value of AFP on HCC development after interferon therapy and its criteria remained uncertain. What is new here: AFP values before interferon therapy have strong predictive value on HCC development after interferon therapy. The simple criteria defined by AFP values before and 1 year after interferon therapy might work efficient to predict HCC development after interferon therapy.