Incidence of HCC in chronic hepatitis C patients with advanced hepatic fibrosis who achieved SVR following DAAs: A prospective study

Abstract

Liver cirrhosis is an important risk factor for hepatocellular carcinoma. The reported annual incidence of HCC is about 3%‐8% in CHC cirrhotic patients. Based on the Cochrane systematic review, there was no clear evidence, on the long‐term clinical effects of DAAs in patients achieving SVR, as regard liver cirrhosis‐related HCC incidence. The aim of the study was to determine the incidence of HCC in chronic hepatitis C patients genotype IV with liver cirrhosis and advanced liver fibrosis after achieving SVR following DAA treatment in a prospective large cohort of HCV patients with long follow‐up. This was a prospective observational cohort study including 2372 CHC patients with advanced liver fibrosis or cirrhosis receiving DAA therapy in outpatient clinics at the Egyptian Liver Research Institute and Hospital since January 2015. Liver fibrosis was assessed using transient elastography. Abdominal ultrasonography and AFP measurement were done at baseline and follow‐up visits every 6 months, in addition to triphasic abdominal MSCT when needed. Patients were followed up after achieving SVR12 for at least 12 months. HCC developed in 109 cases during the follow‐up period (mean 23.60 ± 8.25 months). Overall HCC incidence was 2.338/100 PY, 95% CI = 1.942‐2.814. In patients with cirrhosis, the incidence of HCC was 2.917/100 PY, 95% CI = 2.407‐3.535, while in patients with advanced liver fibrosis the incidence of HCC was 0.664/100 PY, 95% CI = 0.333‐1.326. In conclusion, the incidence of HCC was reduced in chronic hepatitis C genotype 4 patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3) who achieved SVR following DAA therapy.

Low incidence of HCC in chronic hepatitis C patients with pretreatment liver stiffness measurements below 17.5 kilopascal who achieve SVR following DAAs

“…As the negative predictive value for the cut-off of 17.5 kPa was very high at 99.7%, this could suggest that within the first three years after cure for hepatitis C, monoinfected patients with no prior episode of HCC or decompensated cirrhosis and with a pretreatment LSM below 17.5 kPa may not benefit from HCC surveillance. However, patients Our findings are in line with recent study by Shiha et al [31] that followed 2372 patients monoinfected with HCV with no prior episodes of decompensated cirrhosis or HCC who achieved SVR after treatment with DAA for an average of 23.6 months. In 638 patients with a pretreatment LSM of 10.3-16.3 kPa Shiba et al found a HCC incidence rate of 0.664/100 PY compared to 2.917/100 PY among 1734 patients with a pretreatment LSM of �16.4 kPa.…”

GES: A validated simple score to predict the risk of HCC in patients with HCV‐GT4‐associated advanced liver fibrosis after oral antivirals

“…The study included 4400 consecutive patients, with liver cirrhosis and advanced fibrosis who achieved a sustained virologic response (SVR). The derivation cohort included 2372 patients (638 patients with F3 and 1734 with F4 stage) and their characteristics are described previously 14 . The patients were followed for an average of 23.60 ± 8.25 months after the cessation of DAA treatment and during this period, 109 patients developed HCC, with an annual incidence of 2.338/100 per year (95% CI = 1.942‐2.814).…”

Risk of Hepatocellular Carcinoma after HCV Clearance by Direct-Acting Antivirals Treatment Predictive Factors and Role of Epigenetics

“…SVR was associated with a 73% reduction in the overall relative risk for HCC recurrence. An Egyptian cohort of 2372 patients infected by genotype 4 HCV with advanced liver fibrosis and cirrhosis was prospectively followed for at least 12 months [ 38 ]. The overall HCC incidence was 2.3 per 100 patient-years.…”