Serum Agalactosyl IgG Predicts Hepatocellular Carcinoma and All‐Cause Mortality After SVR in Advanced Chronic Hepatitis C
Daisuke Sakon, Jumpei Kondo, Yuki Tahata, Hayato Hikita, Maki Iwaisako, Muya Matsumoto, Asuka Ogata, Shinji Takamatsu, Yasutoshi Nozaki, Naruyasu Kakita, Hisashi Ishida, Fumihiko Nakanishi, Yuichi Yoshida, Masanori Nakahara, Kazuho Imanaka, Mitsuru Sakakibara, Takayuki Yakushijin, Tetsuo Takehara, Takahiro Kodama, Eiji MiyoshiABSTRACT
Background and Aims
Patients with chronic hepatitis C and advanced fibrosis remain at substantial risk of hepatocellular carcinoma (HCC) and non‐liver–related death even after sustained virological response (SVR) to direct‐acting antivirals (DAA). Serum agalactosyl IgG (agal‐IgG) reflects chronic inflammation and fibrogenic activity, but its prognostic value after SVR is unknown. We investigated whether serum agal‐IgG at end of treatment (EOT) predicts HCC and all‐cause mortality in DAA‐treated patients with advanced fibrosis.
Methods
Among 3550 patients with chronic hepatitis C treated with DAAs at Osaka University Hospital and affiliated centers, the stored sera of 136 patients with biopsy‐proven F3–F4 fibrosis before DAA treatment, who achieved SVR, and had no history of HCC were available at EOT. Serum agal‐IgG at EOT was measured using a 42B1‐based ELISA.
Results
During a median follow‐up of 68.7 months (interquartile range, 36.8–84.9) for HCC surveillance, 15 patients developed HCC. Over a median overall follow‐up of 73.7 months (54.5–86.7), 11 patients died. Higher EOT agal‐IgG levels were significantly associated with both HCC occurrence and all‐cause mortality, and these associations remained independent after adjustment for age, sex, and baseline fibrosis (FIB‐4 index). The adjusted hazard ratios per 1‐unit increase in agal‐IgG were 1.050 (95% CI, 1.008–1.094) for HCC and 1.085 (95% CI, 1.035–1.137) for all‐cause mortality. Patients with EOT agal‐IgG levels above the cohort median also showed significantly higher cumulative incidences of HCC and all‐cause death than those with lower levels.
Conclusions
Serum agalactosyl IgG measured at the end of DAA therapy independently predicts HCC and all‐cause mortality after SVR in patients with chronic hepatitis C and advanced fibrosis. EOT agal‐IgG may offer additional prognostic information for post‐SVR risk stratification and help identify patients at higher risk of HCC and all‐cause mortality after SVR.