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Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study

Patients with a chronic hepatitis B virus (HBV) infection who are treated with nucleos(t)ide analogues (NAs) are still at risk for hepatocellular carcinoma (HCC), and it has been clinically questioned whether patients with a high risk of HCC can be identified efficiently. We aimed to clarify the ris...

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Autores principales: Inoue, Jun, Kobayashi, Tomoo, Akahane, Takehiro, Kimura, Osamu, Sato, Kosuke, Ninomiya, Masashi, Iwata, Tomoaki, Takai, Satoshi, Kisara, Norihiro, Sato, Toshihiro, Nagasaki, Futoshi, Miura, Masahito, Nakamura, Takuya, Umetsu, Teruyuki, Sano, Akitoshi, Tsuruoka, Mio, Onuki, Masazumi, Niitsuma, Hirofumi, Masamune, Atsushi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9101732/
https://www.ncbi.nlm.nih.gov/pubmed/35566481
http://dx.doi.org/10.3390/jcm11092354
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author Inoue, Jun
Kobayashi, Tomoo
Akahane, Takehiro
Kimura, Osamu
Sato, Kosuke
Ninomiya, Masashi
Iwata, Tomoaki
Takai, Satoshi
Kisara, Norihiro
Sato, Toshihiro
Nagasaki, Futoshi
Miura, Masahito
Nakamura, Takuya
Umetsu, Teruyuki
Sano, Akitoshi
Tsuruoka, Mio
Onuki, Masazumi
Niitsuma, Hirofumi
Masamune, Atsushi
author_facet Inoue, Jun
Kobayashi, Tomoo
Akahane, Takehiro
Kimura, Osamu
Sato, Kosuke
Ninomiya, Masashi
Iwata, Tomoaki
Takai, Satoshi
Kisara, Norihiro
Sato, Toshihiro
Nagasaki, Futoshi
Miura, Masahito
Nakamura, Takuya
Umetsu, Teruyuki
Sano, Akitoshi
Tsuruoka, Mio
Onuki, Masazumi
Niitsuma, Hirofumi
Masamune, Atsushi
author_sort Inoue, Jun
collection PubMed
description Patients with a chronic hepatitis B virus (HBV) infection who are treated with nucleos(t)ide analogues (NAs) are still at risk for hepatocellular carcinoma (HCC), and it has been clinically questioned whether patients with a high risk of HCC can be identified efficiently. We aimed to clarify the risk factors associated with the development of HCC during NA therapies. A total of 611 chronically HBV-infected patients without a history of HCC, who were treated with NAs for more than 6 months (median 72 months), from 2000 to 2021, were included from 16 hospitals in the Tohoku district in Japan. Incidences of HCC occurrence were analyzed with clinical factors, including on-treatment responses. Alanine aminotransferase (ALT) normalization, based on the criteria of three guidelines, was analyzed with other parameters, including the age–male–ALBI–platelets (aMAP) risk score. During the observation period, 48 patients developed HCC, and the cumulative HCC incidence was 10.6% at 10 years. Non-achievement of ALT normalization at 1 year of therapy was mostly associated with HCC development when ALT ≤ 30 U/L was used as the cut-off (cumulative incidence, 19.9% vs. 5.3% at 10 years, p < 0.001). The effectiveness of the aMAP risk score at the start of treatment was validated in this cohort. A combination of an aMAP risk score ≥ 50 and non-achievement of ALT normalization could stratify the risk of HCC significantly, and notably, there was no HCC development in 103 patients without these 2 factors. In conclusion, non-achievement of ALT normalization (≤30 U/L) at 1 year might be useful in predicting HCC during NA therapies and, in combination with the aMAP risk score, could stratify the risk more precisely.
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spelling pubmed-91017322022-05-14 Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study Inoue, Jun Kobayashi, Tomoo Akahane, Takehiro Kimura, Osamu Sato, Kosuke Ninomiya, Masashi Iwata, Tomoaki Takai, Satoshi Kisara, Norihiro Sato, Toshihiro Nagasaki, Futoshi Miura, Masahito Nakamura, Takuya Umetsu, Teruyuki Sano, Akitoshi Tsuruoka, Mio Onuki, Masazumi Niitsuma, Hirofumi Masamune, Atsushi J Clin Med Article Patients with a chronic hepatitis B virus (HBV) infection who are treated with nucleos(t)ide analogues (NAs) are still at risk for hepatocellular carcinoma (HCC), and it has been clinically questioned whether patients with a high risk of HCC can be identified efficiently. We aimed to clarify the risk factors associated with the development of HCC during NA therapies. A total of 611 chronically HBV-infected patients without a history of HCC, who were treated with NAs for more than 6 months (median 72 months), from 2000 to 2021, were included from 16 hospitals in the Tohoku district in Japan. Incidences of HCC occurrence were analyzed with clinical factors, including on-treatment responses. Alanine aminotransferase (ALT) normalization, based on the criteria of three guidelines, was analyzed with other parameters, including the age–male–ALBI–platelets (aMAP) risk score. During the observation period, 48 patients developed HCC, and the cumulative HCC incidence was 10.6% at 10 years. Non-achievement of ALT normalization at 1 year of therapy was mostly associated with HCC development when ALT ≤ 30 U/L was used as the cut-off (cumulative incidence, 19.9% vs. 5.3% at 10 years, p < 0.001). The effectiveness of the aMAP risk score at the start of treatment was validated in this cohort. A combination of an aMAP risk score ≥ 50 and non-achievement of ALT normalization could stratify the risk of HCC significantly, and notably, there was no HCC development in 103 patients without these 2 factors. In conclusion, non-achievement of ALT normalization (≤30 U/L) at 1 year might be useful in predicting HCC during NA therapies and, in combination with the aMAP risk score, could stratify the risk more precisely. MDPI 2022-04-22 /pmc/articles/PMC9101732/ /pubmed/35566481 http://dx.doi.org/10.3390/jcm11092354 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Inoue, Jun
Kobayashi, Tomoo
Akahane, Takehiro
Kimura, Osamu
Sato, Kosuke
Ninomiya, Masashi
Iwata, Tomoaki
Takai, Satoshi
Kisara, Norihiro
Sato, Toshihiro
Nagasaki, Futoshi
Miura, Masahito
Nakamura, Takuya
Umetsu, Teruyuki
Sano, Akitoshi
Tsuruoka, Mio
Onuki, Masazumi
Niitsuma, Hirofumi
Masamune, Atsushi
Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title_full Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title_fullStr Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title_full_unstemmed Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title_short Non-Achievement of Alanine Aminotransferase Normalization Associated with the Risk of Hepatocellular Carcinoma during Nucleos(t)ide Analogue Therapies: A Multicenter Retrospective Study
title_sort non-achievement of alanine aminotransferase normalization associated with the risk of hepatocellular carcinoma during nucleos(t)ide analogue therapies: a multicenter retrospective study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9101732/
https://www.ncbi.nlm.nih.gov/pubmed/35566481
http://dx.doi.org/10.3390/jcm11092354
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