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

Abstract

Background: Recently, increases in the risk of Hepatocellular carcinoma (HCC) recurrence in patients with hepatitis C virus (HCV) due to the administration of direct antivirals agents (DAA) have been reported. Methods: One hundred and nineteen patients who were treated with DAA and achieved sustained viral response (SVR) were prospectively followed-up for over two years by transient elastography with liver stiffness measurements (LSM). Fourteen out of 119 patients (12%) had a history of being treated for HCC by radiofrequency ablation or resection and achieved complete responses after previous HCC treatments before the initiation of DAA. HCC was diagnosed by contrast-enhanced computed tomography (CT) or enhanced magnetic resonance imaging (MR). CT or MR was performed before the DAA treatment and every 6 months after during the follow-up. LSM was performed at the initiation of DAA (LSM0), at 24 weeks after the start of DAA (LSM24), at 48 weeks after that (LSM48) and at 2 years after that (LSM2y). Results: LSM0, LSM24, LSM48 and LSM2y of 105 patients without HCC were 7.5 (3.0-27.0), 6.0 (2.5-31.6), 4.6 (2.6-25.2) and 4.4 (3.1-29.9) kPa, respectively, showing significant improvements. Three out of 105 patients (2.9%) subsequently developed HCC and their LSM showed improvements. Eight out of fourteen patients (57%) with a history of HCC treatments subsequently developed HCC recurrence.