Long-Term Hepatocellular Carcinoma Development and Predictive Ability of Non-Invasive Scoring Systems in Patients with HCV-Related Cirrhosis Treated with Direct-Acting Antivirals

Abstract

Patients with hepatitis C virus (HCV)-related cirrhosis treated with direct-acting antivirals (DAA) are still at risk of developing hepatocellular carcinoma (HCC). We investigated the accuracy of non-invasive scoring systems (NSS) for the prediction of de novo HCC development in patients treated with DAA on long-term follow-up (FU). We analyzed data from 575 consecutive patients with cirrhosis and no history of HCC who achieved a sustained virologic response (SVR) to DAA therapy. NSS (i.e., Forns index, APRI, FIB-4, ALBI, and aMAP) were calculated at 3 months after the end of therapy. Performance for de novo HCC prediction was evaluated in terms of area under the curve (AUC) and Harrell’s C-index. During a median FU of 44.9 (27.8–58.6) months, 57 (9.9%) patients developed de novo HCC. All five NSS were associated with the risk of de novo HCC. At multivariate analysis, only the ALBI score resulted in being significantly and independently associated with de novo HCC development (adjusted hazard ratio = 4.91, 95% CI 2.91–8.28, p < 0.001). ALBI showed the highest diagnostic accuracy for the detection of de novo HCC at 1-, 3-, and 5-years of FU, with AUC values of 0.81 (95% CI 0.78–0.85), 0.71 (95% CI 0.66–0.75), and 0.68 (95% CI 0.59–0.76), respectively. Consistently, the best predictive performance assessed by Harrell’s C-statistic was observed for ALBI (C-index = 0.70, 95% CI 0.62–0.77). ALBI score may represent a valuable and inexpensive tool for risk stratification and the personalization of an HCC surveillance strategy for patients with cirrhosis and previous history of HCV infection treated with DAA.

Outcomes of Interferon-free Treatment of Hepatitis C Virus Infection Seven Years after Approval and Problems with Drop out during and after Treatment: A Retrospective, Single-center Study

“…The cumulative incidence of HCC after SVR observed in this study was not significantly different from that reported in other studies (22,29,30). HCC occurred sporadically for at least 5 years after SVR with IFN-free treatments in this study involving a population with a mix of patients at high and low risk for HCC.…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…The ALBI score is strongly associated with the degree of hepatic fibrosis, as assessed by the FIB-4 (fibrosis-4) index 81 , 82 or aspartate aminotransferase-to-platelet ratio index (APRI). 83 This observation presumably explains several reports that the ALBI score is an important risk factor for HCC development, 67 , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] particularly after sustained virologic response. [86] , [87] , [88] The best documented risk score for HCC in patients with chronic liver disease is the aMAP score 89 , 90 which combines ALBI with age, male sex and platelet count and may form the basis of a realistic risk stratification strategy.…”

“…The ALBI score is strongly associated with the degree of hepatic fibrosis as assessed by the FIB-4 index [81,82] or APRI [83]. This observation presumably explains several reports that the ALBI score is an important risk factor for HCC development [67,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] particularly after sustained virologic response [86][87][88].…”

“… Caviglia et al. 88 Retrospective 575 HCV Cirrhosis, after SVR Only the ALBI score significantly associated with de novo HCC development among Forns index, APRI, FIB-4, and aMAP. Prediction of liver-related complications other than HCC Hsieh et al.…”

Effectiveness and Safety of Avatrombopag in Liver Cancer Patients with Severe Thrombocytopenia: Real-World Data and Challenges

“…Fibroscan values were measured by ultrasound elastography in 55 patients (44 CLD and 11 non-CLD patients) to assess liver stiffness. The albumin-bilirubin (ALBI) score was calculated as log 10 total bilirubin ( μ mol/L) × 0.66 + albumin (g/L) × −0.085 [ 17 ]. This study was approved by the Research Ethics Committee, Zhongshan Hospital Fudan University.…”