Early recurrence of hepatocellular carcinoma in patients with HCV infection followed by transient elastography for two years after successful treatment with daclatasvir plus asunaprevir

Abstract

Aim and background: Recent advances have been achieved in HCV treatments because direct-acting antivirals (DAA) result in a sustained viral response (SVR) in more than 90% of HCV-infected patients, even those with severe fibrosis. However, an unexpected high rate of HCC recurrence following DAA has been reported. The aim of this study was to prospectively evaluate the relationship between the occurrence or recurrence of HCC and regression of fibrosis followed by transient elastography for two years after successful treatment with daclatasvir plus asunaprevir (DCV plus ASV) in patients with HCV infection.Method: Forty-four patients who were treated with DCV plus ASV for 24 weeks and achieved SVR were followed-up for two years and analyzed. Eight patients had a history of being treated for HCC by radiofrequency ablation (RFA) or resection. Transient elastography (Fibroscan®) with liver stiffness measurements (LSM) was performed at the initiation of DCV plus ASV, at the end of the treatment (EOT), and 24 and 72 weeks after the treatment. Results:The occurrence of HCC was not detected during the follow-up. Three out of eight patients with a history of HCC treatment subsequently developed radiological HCC recurrence a few months after the treatment with DCV plus ASV. LSM values measured by Fibroscan at the initiation of DCV plus ASV increased to 19.1, 13.1, and 26.0 kPa in Cases 1, 2, and 3, respectively, while those at EOT were 12.8, 12.0, and 26.6 kPa, respectively. The five other patients with LSM values less than 12 kPa at the last Fibroscan have shown no recurrence. Conclusion:Chronic hepatitis C patients previously treated for HCC with high LSM values before and after DAA may be at a high risk of HCC recurrence, suggesting that strict HCC surveillance is required even after the achievement of SVR by DAA.

Liver Stiffness Measurement Is Useful to Predict Early Recurrence of Hepatocellular Carcinoma after Sustained Virological Responses by Direct Antiviral Agents in Patients with Hepatitis C

“…All our patients were treated with potentially curative treatments, resection and RFA, HCC recurrence was noted between one and fifteen months after three kinds of DAA; DCV plus ASV three cases, SOF plus LDV three cases and SOF plus RBV two cases. We reported that three out of eight patients treated with resection and RFA developed HCC recurrence from three to five months after DCV plus ASV (16). DCV plus ASV was approved only in Japan and Korea of over the world, therefore the aim of the present study was to prospectively evaluate the relationship between the recurrence of HCC and liver stiffness values after the successful treatment of patients with HCV infection with all kinds of DAA.…”

“…In the DAA therapy HCC recurrence more significantly recognized in the cirrhotic patients with LSM values over 21.5 kPa before DAA therapy [15]. We reported that chronic hepatitis C patients previously treated for HCC with high LSM values before and after DCV plus ASV might be at elevated risk of HCC recurrence [16]. DCV plus ASV was approved only in Japan and Korea of over the world; therefore the aim of the present study was to prospectively evaluate the relationship between the recurrence of HCC and liver stiffness values by transient elastography after the successful treatment of patients with HCV infection with all DAA containing SOF plus LDV, OBV plus PTV with rit and SOF plus RBV.…”