Combining the age-male-albumin-bilirubin-platelets score and shear wave elastography stratifies carcinogenic risk in hepatitis C patients after viral clearance

Figure 1 Flow chart of the study. A total of 292 hepatitis C patients who obtained sustained virological response using direct-acting antiviral agent treatment were entered. Six patients who were lost to follow-up and 7 patients who were followed for less than 6 mo were excluded, and 279 patients were included in the analysis.

Figure 2 Changes over time in the age-male-albumin-bilirubin-platelets score and velocity of shear waves. The age-male-albumin-bilirubin-platelets score is 58.7 ± 8.6 at baseline, 57.8 ± 8.5 at end of treatment, 57.6 ± 8.2 at follow-up 12, and 57.5 ± 8.2 at follow-up 24. No significant fluctuations are seen (P = 0.1862, P = 0.7886, P = 0.8205). A: Velocity of shear waves is 1.55 ± 0.25 m/s at baseline, 1.47 ± 0.25 m/s at end of treatment, 1.43 ± 0.24 m/s at follow-up 12, and 1.43 ± 0.25 m/s at follow-up 24; B: It decreases with time from baseline to follow-up 12, and no significant difference is seen between follow-ups 12 and 24 (P < 0.0001, P = 0.0004, P = 0.7814). EOT: End of treatment.

Figure 3 Percentage of hepatocelllular carcinoma onset by the age-male-albumin-bilirubin-platelets score at follow-up 12. No patients develop cancer during the follow-up period in the low-risk group of patients with age-male-albumin-bilirubin-platelets scores < 50. Carcinogenesis is seen in 1.7% of patients in the medium-risk group, with scores of 50-59, and 8.3% of patients in the high-risk group, with scores ≥ 60.

Figure 4 Percentage of hepatocellular carcinoma onset in the age-male-albumin-bilirubin-platelets score medium-risk and high-risk group stratified by Velocity of shear waves. Using the velocity of shear waves cut-off value (1.53 m/s) for hepatocarcinogenesis calculated using the receiver-operating characteristic curve, further stratification is done in the medium-risk and high-risk groups by the age-male-albumin-bilirubin-platelets score. Carcinogenesis is seen in 2.0% of the group with velocity of shear waves < 1.53 m/s and in 10.5% of the group with velocity of shear waves ≥ 1.53 m/s.