title: Post-treatment levels of α-fetoprotein predict long-term hepatocellular carcinoma development after sustained virological response in patients with hepatitis C.
abstract: OBJECTIVE
  The rate of hepatocellular carcinoma (HCC) development is reportedly lower in patients with chronic hepatitis C virus (HCV) who have achieved a sustained virological response (SVR) than in patients who were unresponsive to therapy. However, the development of HCC is sometimes observed in patients with SVR. Therefore, we clarified the predictive power of clinical factors for HCC incidence in patients with SVR using receiver operating characteristic (ROC) curve analysis that takes time dependence into account.
  
  
  METHODS
  A total of 571 patients with HCV who achieved SVR with interferon-based therapy were enrolled. Univariate and multivariate Cox proportional hazards models and time-dependent ROC curves were used to analyze clinical factors associated with the development of HCC.
  
  
  RESULTS
  Twenty-four patients developed HCC during the follow-up period (median duration, 9.0 years). The 5-, 10-, 15-, and 20-year cumulative incidence rates for HCC were 1.7%, 4.8%, 5.8%, and 6.6%, respectively. Multivariate Cox proportional hazards models showed that older age (hazard ratio [HR], 3.648), male sex (HR, 7.560), lower platelet count at 24 weeks after the end of treatment (SVR24) (HR, 3.939), and higher α-fetoprotein (AFP) at SVR24 (HR, 3.630) were independently associated with HCC development. In addition, time-dependent ROC analysis showed that, compared to platelet count at SVR24, AFP at SVR24 had higher predictive power for HCC incidence approximately 7 years after SVR.
  
  
  CONCLUSIONS
  Elevated AFP at SVR24 is a risk factor for HCC in patients with HCV, even those who achieve SVR. α-Fetoprotein is a good predictor of HCC development.
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Seiki
authors.initials: S
authors.lastname: Kiriyama
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tanikawa
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hisanaga
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kanamori
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Kitabatake
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Tsuyoki
authors.initials: T
authors.lastname: Yama
authors.affiliation: Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Tanaka
keywords: hepatitis C; hepatocellular carcinoma; sustained virological response; time-dependent receiver operating characteristic; α-fetoprotein