Immune inflammation indicators and ALBI score to predict liver cancer in HCV-patients treated with direct-acting antivirals

Andrea Casadei Gardini,Francesco Giuseppe Foschi,Fabio Conti,Elisabetta Petracci,Ranka Vukotic,Giorgia Marisi,Federica Buonfiglioli,Giovanni Vitale,Federico Ravaioli,Stefano Gitto,Gabriella Verucchi,Marco Lenzi,Luigi Bolondi,Giuseppe Mazzella,Stefano Brillanti,Pietro Andreone

doi:10.1016/j.dld.2018.09.016

Abstract

BackgroundUnexpectedly high occurrence or recurrence rate of hepatocellular carcinoma (HCC) has been observed in patients with chronic hepatitis C receiving direct-acting antivirals (DAAs) therapy. AimsWe evaluated the predictive value of albumin-bilirubin (ALBI) score and immune-inflammation indicators to identify the risk of occurrence or recurrence of HCC in patients treated with DAAs in a real life setting. MethodsIn this retrospective cohort study, we analysed data from 514 patients with cirrhosis who were prospectively enrolled for treatment with DAAs. We assessed baseline neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR), aspartate aminotransferase-lymphocyte ratio (ALRI) index and ALBI score. ResultsIn patients with no history of HCC (N = 416), increased AST, bilirubin, ALRI, and ALBI score, and decreased albumin and platelets were significantly associated with an increased risk of HCC development, at univariate analysis. At multivariate analysis, increase in ALBI grade (p = 0.038, HR: 2.35, 95% CI: 1.05–5.25) and decrease in platelets (p = 0.048, HR: 0.92, 95% CI: 0.85–1.0) were independently associated with HCC development. In patients with previous HCC (N = 98), adjusting for the time from HCC treatment, increased ALRI (p = 0.008, HR: 1.05, 95% CI: 1.01–1.09) was significantly associated with a risk of recurrence. ConclusionALBI score, platelet count and ALRI are promising, easy to perform and inexpensive tools for identifying patients with higher risk of HCC after treatment with DAAs.

Highlights

Interferon(IFN)-free regimen using new direct acting antivirals (DAAs) has represented a turning point in the treatment of patients with chronic hepatitis C [1]
A 10-unit increase of AST (p = E 0.036, hazard ratios (HRs): 1.06, 95% confidence intervals E (CIs): 1.01–1.12), a 1-unit increase of bilirubin (p = 0.035, HR: T 1.46, 95% CI: 1.03–2.08), a 10-unit increase of aminotransferase-lymphocyte ratio C (ALRI) (p =0.002, HR: 1.07, 95% CI: EP 1.02–1.11), and a 1-unit increase in ALBI score (p = 0.001, HR: 2.99, 95% CI: 1.45– C 6.15) were significantly associated with a higher hazard of hepatocellular carcinoma (HCC) occurrence
M This study evaluated ALBI score and immune-inflammation parameters as potential predictors of HCC occurrence or recurrence in patients treated with DAA for chronic

Summary

Introduction

Interferon(IFN)-free regimen using new direct acting antivirals (DAAs) has represented a turning point in the treatment of patients with chronic hepatitis C [1]. The impact of DAAs-based treatment on the development of hepatocellular carcinoma (HCC) in patients with cirrhosis has grown controversial due to potential clinical. T implications, for HCC recurrence after a successful curative treatment. IP Some studies have recently reported an unexpectedly high HCC recurrence rate of 27R 29% among subjects treated with liver resection or ablation, who had received DAAs C therapy [2,3,4]. S The mechanism that could explain such a high rate of tumor recurrence after DAAs U treatment is one of the main topics of these studies. Microenvironment and viralAN induced inflammation are supposed to play a key role in chronic liver injury and tumor M initiation [10]. The human immune system itself has an anti-tumor function [11]. There is a complex yet fragile balance between the pro- and anti-

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