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Advantage of liver stiffness measurement before and after direct‐acting antiviral therapy to predict hepatocellular carcinoma and exacerbation of esophageal varices in chronic hepatitis C
Author(s) -
Ogasawara Nobuhiko,
Saitoh Satoshi,
Akuta Norio,
Sezaki Hitomi,
Suzuki Fumitaka,
Fujiyama Shunichiro,
Kawamura Yusuke,
Hosaka Tetsuya,
Kobayashi Masahiro,
Suzuki Yoshiyuki,
Arase Yasuji,
Ikeda Kenji,
Kumada Hiromitsu
Publication year - 2020
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13467
Subject(s) - hepatocellular carcinoma , cirrhosis , medicine , exacerbation , gastroenterology , esophageal varices , fibrosis , chronic hepatitis , immunology , portal hypertension , virus
Aim The risk of development of hepatocellular carcinoma (HCC) persisted in patients with advanced fibrosis, even after achieving sustained virologic response (SVR). This study aimed to show the advantage of liver stiffness measurement (LSM) at baseline and after SVR to predict HCC occurrence and esophageal varices (EV) exacerbation. Methods These risks were evaluated in 398 chronic hepatitis C patients without a history of HCC who achieved SVR after direct‐acting antiviral agent and evaluated LSM at least twice during follow up. We defined liver cirrhosis and chronic hepatitis as LSM of ≥12 kPa and <12 kPa, respectively. Results LSM was significantly correlated with serum fibrosis markers, such as Fib‐4 index and Wisteria floribunda agglutinin‐positive Mac‐2 binding protein, at baseline and SVR at 24 weeks after treatment (SVR24). Five patients received preventive treatment of EV, but no EV bleeding occurred after SVR, and their LSM at baseline and SVR24 was significantly higher than that of other cirrhosis patients. The annual rate of HCC during the first 4 years was 1.5%. LSM in HCC patients tended to decrease after direct‐acting antiviral agent therapies, but significantly higher than that of cirrhosis patients without HCC before and after treatment. Multivariate analysis identified LSM and alpha‐fetoprotein at baseline and LSM at SVR24 as significant independent predictors of HCC. Conclusions Evaluating LSM not only at baseline, but also SVR24, was found to be useful for the detection of advanced fibrosis patients at high risk of HCC occurrence and EV exacerbation. We recommend focused surveillance of HCC and EV for these patients.