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
ARTICLE HIGHLIGHTS
Research background

The treatment of hepatitis C with direct-acting antiviral agents (DAAs) produces a high rate of sustained virological response (SVR). But even after SVR, a certain number of patients develop cancer. Therefore, predicting the risk of carcinogenesis is important in such patients.

Research motivation

Both the age-male-albumin-bilirubin-platelets (aMAP) score and the velocity of shear waves (Vs) measured by shear wave elastography (SWE) have been shown to be useful for stratifying the risk of hepatocellular carcinoma (HCC) in hepatitis C who achieved SVR following DAAs therapy. We considered that combining the aMAP score with Vs improve the prediction of carcinogenic risk.

Research objectives

Objective of this study is to determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.

Research methods

Hepatitis C patients who achieved SVR with DAA therapy were enrolled. The medium-risk and high-risk groups with aMAP scores ≥ 50 at 12 wk (follow-up12) after treatment were divided into non-carcinogenic and carcinogenic groups. Clinical parameters in which significant differences were seen between non-carcinogenic and carcinogenic groups were taken as explanatory variables, and multiple regression analysis was performed with the presence or absence of carcinogenesis as the target variable. The diagnostic performances of clinical parameters for predicting the presence of HCC were evaluated using receiver-operating characteristic (ROC) curve analyses.

Research results

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 calculated using the ROC curve for liver carcinogenesis was 1.53 m/s. When medium-risk and high-risk group people were stratified using this cut-off value, carcinogenesis was seen 2.0% from the group with Vs < 1.53 m/s 10.5% from the group with Vs ≥ 1.53 m/s.

Research conclusions

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

Research perspectives

Concentrated surveillance of patients selected for higher carcinogenesis risk will be more efficient than uniform surveillance of all patients after SVR.