Post-treatment Mac-2-Binding Protein is a Useful Predictor of Hepatocellular Carcinoma Development after Hepatitis C Virus Eradication

Abstract Background and aims: Recent advances of direct-acting antiviral drugs for hepatitis C virus (HCV) have dramatically improved the sustained virologic response (SVR) rate, but hepatocellular carcinoma (HCC) development not rarely occurs even in patients who achieve an SVR. Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA + -M2BP) was recently developed as a noninvasive biomarker of liver fibrosis. However, the association between the WFA + -M2BP level and HCC development after the achievement of an SVR is unclear. Methods: We examined the association between WFA + -M2BP and HCC development in 552 HCV patients who achieved an SVR (Interferon [IFN]-based therapy, n=228; IFN-free therapy, n=294). Results: Multivariate analysis revealed that a high WFA + -M2BP level at SVR week 24 after treatment (SVR24) (hazard ratio [HR]=1.215, P=0.020), low platelet counts (HR=0.876, P=0.037) and old age (HR=1.073, P=0.012) were independent risk factors for HCC development regardless of the treatment regimen. Receiver operator characteristics curve analysis revealed that an WFA + -M2BP level at SVR24 of ≥1.62 cut off index (COI) was the cut-off value for the prediction of HCC development (adjusted HR = 12.565, 95% CI 3.501-45.092, P<0.001). The 3- and 5-year cumulative incidences of HCC were 0.7% and 0.7% in patients with low WFA + -M2BP at SVR24 (<1.62 COI), and 4.8% and 12.4% in patients with high WFA + -M2BP (≥1.62 COI) were, respectively (P<0.001). Conclusion: The assessment of liver fibrosis using the WFA + -M2BP level at SVR24 is a useful predictor of HCC development after HCV eradication even in the IFN-free therapy era.