title: High serum alanine aminotransferase levels for the first three successive years can predict very high incidence of hepatocellular carcinoma in patients with Child Stage A HCV-associated liver cirrhosis.
abstract: Abstract Objective. To assess retrospectively whether continuously high serum alanine aminotransferase (ALAT) levels (<80 IU) in the first three successive years after the diagnosis of liver cirrhosis (LC) are predictive of a subsequent high incidence of hepatocellular carcinoma (HCC) in patients with Child Stage A hepatitis C virus (HCV)-LC. Material and methods. The study comprised 132 HCV-LC (Child Stage A) patients who had not received interferon therapy but had been treated with anti-inflammatory agents. At the end of a 3-year follow-up after the diagnosis of LC, the patients were subdivided into three groups according to their serum ALAT levels and the subsequent incidence of HCC was assessed. Results. The cumulative incidence of HCC starting from 3 years after the diagnosis of LC in the continuously high ALAT group (annual average over 3 years always > or =80 IU; n=41; Group A) was markedly higher than that in the continuously low ALAT group (always <80 IU; n=48; Group B) (p<0.005) during an observation period of 7.9+/-3.7 years. The incidence of HCC in Group A was 11.8%/year. The odds ratios of developing HCC in Group A and Group C (mixed high and low ALAT levels; n=43) were 5.1-fold and 1.5-fold that of Group B, respectively. A multivariate analysis revealed that the ALAT group was independently associated with HCC development. Conclusions. Continuously high ALAT levels for three successive years following the diagnosis of LC can be predictive of a very high incidence of HCC in Child A HCV-LC patients. Prospective trials using therapeutic approaches aimed at decreasing ALAT levels are necessary in order to confirm a positive impact of ALAT reduction on the incidence of HCC in patients with HCV-LC.
authors.affiliation: Department of Gastroenterology, Kanagawa Cancer Center Hospital, Yokohama, Japan. miya220@nifty.com
authors.forename: Kaoru
authors.initials: K
authors.lastname: Miyakawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tarao
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohshige
authors.forename: Soichiro
authors.initials: S
authors.lastname: Morinaga
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohkawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Okamoto
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Shigeru
authors.initials: S
authors.lastname: Adachi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Miura
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Fujiyama
authors.forename: Shiho
authors.initials: S
authors.lastname: Miyase
authors.forename: Kimio
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000201:enzymology* / Q000453:epidemiology / Q000209:etiology; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000201:enzymology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000201:enzymology* / Q000821:virology; D008113:Liver Neoplasms / Q000201:enzymology* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D004279:DNA, Viral; D000410:Alanine Transaminase