Progressive fibrosis significantly correlates with hepatocellular carcinoma in patients with a sustained virological response

Abstract

Progressive fibrosis, assessed by sequential biopsies, was significantly correlated with development of hepatocellular carcinoma in patients who had achieved a sustained virological response for hepatitis C virus.

Management of the patient with SVR

“…In another study using morphometric analysis of paired liver biopsy, 38 patients with cirrhosis who achieved SVR and followed for 5 years showed 61% regression of fibrosis [30]. In a long-term study of 97 patients with SVR with sequential biopsies on average 5.8 year apart, fibrosis stage regressed in 44 patients (45%), was unchanged in 47 patients (48%) and progressed in 6 patients (6%) [31]. In another study of patients followed for a mean of 10 years and using FibroTest and elastography to assess cirrhosis change, regression was seen in 24/43 (56%) with cirrhosis, but 15/128 new cirrhosis cases occurred in those without cirrhosis, yielding a net reduction in cirrhosis of only 5.3% [(24-15) = 9/171); (2.4-9.8%)] [32].…”

“…The factors most consistently linked with regression of fibrosis are lower stages of fibrosis at the time of SVR, younger age (<40 years), female gender, and body mass index (BMI) <27 kg/m 2 [33]. On the other extreme, some patients, despite achieving SVR, will have continued progression and be at risk for decompensated cirrhosis, liver failure and/or hepatocellular carcinoma (HCC) [31,32]. The factors associated with risk of liver-related complications in future as shown in Table 2.…”

“…The factors associated with risk of liver-related complications in future as shown in Table 2. The presence of cirrhosis and portal hypertension pre-SVR are associated with higher likelihood of progression [31,34].…”

“…However, patients who continued to exhibit F3 or F4 fibrosis are still at risk for developing HCC [55,38,56]. A meta-analysis by Messori et al, which included 25 studies from different parts of the world, showed a risk reduction of 6.7% (95% CI: 5-8) in non-cirrhotic patients vs. 22% (95% CI: [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] in patients with cirrhosis [57]. Accordingly, patients with advanced fibrosis and cirrhosis should continue to undergo surveillance for HCC every six months using ultrasonography with or without alpha-fetoprotein [38,52].…”

Liver stiffness measurement predicts hepatocellular carcinoma development in patients treated with direct‐acting antivirals

“…The elimination of HCV will prevent the progression of chronic hepatitis and associated complications 5. Several studies have reported that achievement of SVR results in the resolution of liver fibrosis6, 7 and a decreased incidence of HCC 8. However, development of HCC is sometimes seen even in patients who achieve SVR after DAA treatment, indicating the need for continuous surveillance for HCC after the eradication of HCV 9, 10, 11, 12.…”