Short‐term risk of hepatocellular carcinoma after hepatitis C virus eradication following direct‐acting anti‐viral treatment
Author(s) -
Ogawa E.,
Furusyo N.,
Nomura H.,
Dohmen K.,
Higashi N.,
Takahashi K.,
Kawano A.,
Azuma K.,
Satoh T.,
Nakamuta M.,
Koyanagi T.,
Kato M.,
Shimoda S.,
Kajiwara E.,
Hayashi J.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14380
Subject(s) - medicine , hepatocellular carcinoma , cumulative incidence , gastroenterology , cirrhosis , proportional hazards model , hazard ratio , hepatitis c virus , sofosbuvir , hepatitis c , incidence (geometry) , cohort , log rank test , virus , confidence interval , immunology , ribavirin , physics , optics
Summary Background With the development of direct‐acting anti‐virals ( DAA s), almost all patients with chronic hepatitis C virus ( HCV ) infection can achieve sustained viral response ( SVR ). Aim To evaluate the short‐term risk of HCC among patients with SVR by DAA s, including those with cirrhosis or previous HCC . Methods This large‐scale, multicentre cohort study included 1,675 consecutive patients who achieved SVR by treatment with interferon‐free sofosbuvir‐based regimens, divided into groups with ( n = 152) or without previous HCC ( n = 1,523). The Kaplan‐Meier method and Cox proportional hazard analysis were used to calculate the cumulative HCC incidence and related factors of HCC . Results During the follow‐up period (median: 17 months), 46 (2.7%) patients developed HCC . The 1‐year cumulative rates of de novo HCC were 0.4% and 4.9% for the noncirrhosis and cirrhosis groups respectively (log‐rank test: P < 0.001). For cirrhotic patients, serum α‐fetoprotein level at the end of treatment ( EOT ‐ AFP ) was the strongest predictor of de novo HCC . The 1‐year cumulative de novo HCC rates were 1.4% and 13.1% in the EOT ‐ AFP < 9.0 ng/ mL and ≥ 9.0 ng/ mL groups (cut‐off value) respectively (log‐rank test: P < 0.001). The 1‐year cumulative rates of HCC recurrence were 6.5% and 23.1% for the noncirrhosis and cirrhosis groups respectively (log‐rank test: P = 0.023). For cirrhotic patients, previous HCC characteristics were significantly associated with HCC recurrence. In contrast, sex, age and metabolic features did not influence de novo HCC or recurrence. Conclusions For cirrhotic patients after elimination of HCV , serum EOT ‐ AFP level and previous HCC characteristics would be useful markers for predicting de novo HCC or recurrence.