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Late development of hepatocellular carcinoma after viral clearance in patients with chronic hepatitis C: A need for continual surveillance
Author(s) -
Tong Myron J,
Theodoro Carmem F,
Salvo Rebecca T
Publication year - 2018
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12615
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , gastroenterology , incidence (geometry) , hazard ratio , hepatitis c , hepatitis b , confidence interval , physics , optics
OBJECTIVE Eradication of chronic hepatitis C (CHC) infection decreases the incidence of hepatocellular carcinoma (HCC), but a risk remains. We aimed to investigate HCC development‐associated factors in CHC patients with sustained virological response (SVR) after antiviral therapies. METHODS We compared CHC patients achieving SVR from 1996–2016 who did and did not develop HCC. Their median follow‐up period was 8.01 years. RESULTS Compared with 164 non‐HCC SVR patients, 22 who developed HCC were older at SVR ( P = 0.032), had a higher incidence of diabetes ( P = 0.013) and higher pre‐antiviral treatment alpha‐fetoprotein (AFP) levels ( P = 0.016), more had fibrosis stage 3 and cirrhosis ( P = 0.0009) and hepatitis B core antibody (anti‐HBc) positivity ( P = 0.006). Eight and seven of 22 patients, respectively, developed HCC at 4–10 years and 10 years after SVR. The longest duration from SVR to HCC was 18.7 years. Independent factors associated with HCC development were anti‐HBc positivity (hazard ratio [HR] 5.57, P = 0.012), age at SVR (HR 1.08, P = 0.014), higher pre‐antiviral treatment AFP levels (HR 1.01, P = 0.01) and Hispanic ethnicity (HR 12.9, P = 0.002). HCC risk was significantly less in genotype 2 patients (HR 0.2, P = 0.02) or in those with higher pre‐antiviral treatment albumin levels (HR 0.33, P = 0.04). CONCLUSIONS The risk for HCC exists in a subset of CHC patients after SVR and may occur up to 18 years after viral clearance. Indefinite HCC surveillance is necessary in SVR patients with other risk factors.