Aspartate aminotransferase to platelet ratio index as a prospective predictor of hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection

作者：Hann, Hie-Won; Wan, Shaogui; Lai, Yinzhi; Hann, Richard S.; Myers, Ronald E.; Patel, Fenil; Zhang, Kejin; Ye, Zhong; Wang, Chun; Yang, Hushan^*

来源：Journal of Gastroenterology and Hepatology, 2015, 30(1): 131-138.

DOI：10.1111/jgh.12664

• APRI
• HBV
• HCC

Background and AimAPRI (aspartate aminotransferase [AST] to platelet ratio index) is widely used to assess fibrosis and cirrhosis risk, especially in hepatitis C virus (HCV)-infected patients. Few studies have evaluated APRI and hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) risk. Prospective evidence is needed to assess whether APRI predicts HCC risk in HBV patients.
MethodIn a prospectively enrolled clinical cohort of 855 HBV patients with a 1-year exclusion window (followed for >1 year and did not develop HCC within 1 year), the predictive value of APRI in HCC risk was evaluated by Cox proportional hazards model using univariate and multivariate analyses and longitudinal analysis.
ResultsHigher APRI prospectively conferred a significantly increased risk of HCC in univariate analysis (quartile analysis, P trend=2.9x10(-7)). This effect remained highly significant after adjusting for common host characteristics but not cirrhosis (P trend=7.1x10(-5)), and attenuated when cirrhosis is adjusted (P trend=0.021). The effect remained prominent when the analysis was restricted to patients with a more stringent 2-year exclusion window (P trend=0.008 in quartile analysis adjusting all characteristics including cirrhosis), indicating that the association was unlikely due to including undetected HCC patients in the cohort, thus minimizing the reverse-causation limitation in most retrospective studies. Longitudinal comparison demonstrated a persistently higher APRI value in HBV patients who developed HCC during follow-up than those remaining cancer free.
ConclusionAPRI might be a marker of HCC risk in HBV patients in cirrhosis-dependent and -independent manners. Further studies are warranted to validate this finding and test its clinical applicability in HCC prevention.

• 出版日期2015-1
• 单位河南大学