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Gastroenterology. 2019 Jul 26. pii: S0016-5085(19)41130-X. doi: 10.1053/j.gastro.2019.07.033. [Epub ahead of print]

Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients with Baseline Cirrhosis or High FIB-4 Scores.

Author information

1
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA; Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA. Electronic address: georgei@medicine.washington.edu.
2
Division of General Internal Medicine, Department of Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
3
Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA.
4
Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas TX.
5
Division of Gastroenterology and Hepatology, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor MI.
6
Division of Gastroenterology, Department of Medicine, Virginia Commonwealth University, Richmond, VA.
7
Toronto Centre for Liver Disease, University Health Network, Sandra Rotman Centre for Global Health, University of Toronto.
8
Division of Gastroenterology, Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center and Perelman University of Pennsylvania School of Medicine, Philadelphia, PA.
9
Section of Digestive Diseases, Yale School of Medicine, New Haven, CT and VA Connecticut Healthcare System, West Haven, CT.

Abstract

BACKGROUND & AIMS:

It is unclear if hepatocellular carcinoma (HCC) risk declines over time after hepatitis C virus (HCV) eradication. We analyzed changes in HCC annual incidence over time following HCV eradication and identified dynamic markers of HCC risk.

METHODS:

We identified 48,135 patients who initiated HCV antiviral treatment from 2000 through 2015 and achieved a sustained virologic response (SVR) in the Veterans Health Administration (29,033 treated with direct-acting antiviral (DAA) agents and 19,102 treated with interferon-based regimens). Patients were followed after treatment until February 14, 2019 (average 5.4 years), during which 1509 incident HCCs were identified.

RESULTS:

Among patients with cirrhosis before treatment with DAAs (n=9784), those with pre-SVR fibrosis-4 (FIB-4) scores ≥3.25 had a higher annual incidence of HCC (3.66%/year) than those with FIB-4 scores <3.25 (1.16%/year) (adjusted hazard ratio, 2.14; 95% CI, 1.66-2.75). In DAA-treated patients with cirrhosis and FIB-4 scores ≥3.25, annual HCC risk decreased from 3.8%/year in the first year after SVR to 2.4%/year by the fourth year (P=.01). In interferon-treated patients with FIB-4 scores ≥3.25, annual HCC risk remained above 2%/year, even 10 years after SVR. A decrease in FIB-4 scores from ≥3.25 pre-SVR to <3.25 post-SVR was associated with an approximately 50% lower risk of HCC, but the absolute annual risk remained above 2%/year. Patients without cirrhosis before treatment (n=38,351) had a low risk of HCC, except for those with pre-SVR FIB-4 scores ≥3.25 (HCC risk 1.22%/year) and post-SVR FIB-4 scores≥3.25 (HCC risk 2.39%/year)-risk remained high for many years after SVR.

CONCLUSIONS:

Patients with cirrhosis before an SVR to treatment for HCV infection continue to have a high risk for HCC (>2%/year) for many years, even if their FIB-4 score decreases, and should continue surveillance. Patients without cirrhosis but with FIB-4 scores ≥3.25 have a high enough risk to merit HCC surveillance, especially if FIB-4 remains ≥3.25 post-SVR.

KEYWORDS:

liver cancer; long-term outcome; population; prognostic factor

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