title: Risk factors of hepatocellular carcinoma development in non-cirrhotic patients with sustained virologic response for chronic hepatitis C virus infection.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) can develop in patients with chronic hepatitis C after they have achieved a sustained virologic response (SVR) to antiviral therapy, that is eradication of hepatitis C virus (HCV). Thus, surveillance for HCC remains necessary after SVR. We investigated factors that are predictive of HCC in HCV-infected patients who achieved SVR.
  
  
  METHODS
  The incidence and risk factors for HCC were evaluated in 522 patients who achieved SVR with interferon-based antiviral therapy for HCV. Patients maintained regular follow-up every 6 months for HCC surveillance. The FIB-4 index and aspartate aminotransferase to platelet count ratio index were calculated based on laboratory data at the time that SVR was documented (SVR24).
  
  
  RESULTS
  Patients continued follow-up visits for 1.0-22.9 years (median, 7.2 years) after SVR. HCC developed in 18 patients. The incidence of HCC was 1.2% at 5 years and 4.3% at 10 years. The use of peginterferon or ribavirin for treatment and a history of antiviral therapy prior to the course when SVR was achieved were not associated with the incidence of HCC after SVR. The presence of diabetes mellitus (risk ratio 2.08; P = 0.0451) and FIB-4 index calculated at the time of SVR24 (risk ratio 1.73; P = 0.0198) were associated with a higher likelihood of HCC after SVR by multivariate analysis.
  
  
  CONCLUSIONS
  Patients with diabetes mellitus and patients with the elevation of FIB-4 index at SVR24 are at higher risk of HCC after SVR. Surveillance for HCC should be continued in this patient subpopulation.
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Hidenori
authors: H
authors: Toyoda
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Takashi
authors: T
authors: Kumada
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Toshifumi
authors: T
authors: Tada
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Seiki
authors: S
authors: Kiriyama
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Makoto
authors: M
authors: Tanikawa
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Yasuhiro
authors: Y
authors: Hisanaga
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Akira
authors: A
authors: Kanamori
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Shusuke
authors: S
authors: Kitabatake
authors: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Takanori
authors: T
authors: Ito
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D015994:Incidence; D016898:Interferon-alpha / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: antiviral therapy; chronic hepatitis C; hepatocellular carcinoma; risk factors; sustained virologic response