Published in:
01-04-2013 | Original Article—Liver, Pancreas, and Biliary Tract
Incidence of hepatocellular carcinoma in HCV-infected patients with normal alanine aminotransferase levels categorized by Japanese treatment guidelines
Published in: Journal of Gastroenterology | Issue 4/2013
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Background
This study was conducted to evaluate Japanese treatment guidelines for patients with chronic hepatitis C virus (HCV) infection and normal alanine aminotransferase (N-ALT) levels from the viewpoint of the incidence of hepatocellular carcinoma (HCC).
Methods
Four groups of patients with chronic HCV infection treated with pegylated interferon (Peg-IFN) plus ribavirin, and classified according to the N-ALT guidelines, were examined for HCC incidence: group A (n = 353), ALT ≤30 IU/L and platelet (PLT) ≥15 × 104/mm3; group B (n = 123), ALT ≤30 IU/L and PLT <15 × 104/mm3; group C (n = 233), 30 < ALT ≤ 40 IU/L and PLT ≥15 × 104/mm3; and group D (n = 100), 30 < ALT ≤ 40 IU/L and PLT <15 × 104/mm3. The mean observation period was 36.2 ± 16.5 months
Results
In groups A and C, the HCC incidence was low even in patients with non-response (NR) (cumulative rates at 3 years, 0.0 and 2.9 %, respectively). In groups B and D, 14.5 and 5.3 % of NR patients had developed HCC at 3 years, but none of the patients with sustained virologic response (SVR) or relapse had developed HCC. In group B, no patients with mild fibrosis developed HCC irrespective of the antiviral effect of the treatment. Among patients with PLT <15 × 104/mm3 (group B plus group D), the HCC incidence was significantly lower in patients with SVR and relapse than in NR patients (p < 0.001, p = 0.021, respectively).
Conclusion
These results suggest that N-ALT patients with PLT <15 × 104/mm3 could be candidates for early antiviral therapy.