Liver Center, Huntington Medical Research Institutes, Pasadena, California.
Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Hospital Federal Dos Servidores do Estado, Rio de Janeiro, Brazil.
BACKGROUND & AIMS:
Successful eradication of chronic hepatitis C (CHC) infection decreases the incidence of hepatocellular carcinoma (HCC), but a risk remains. We investigated factors associated with HCC development in CHC patients who had sustained virologic response (SVR) after antiviral therapies.
We retrospectively compared CHC patients achieving SVR to antiviral treatments between 1996 and 2016 who did and did not develop HCC. Their median follow-up period was 8.01 years.
Compared to 164 non-HCC SVR patients, 22 who developed HCC were older in age at SVR (59 vs. 52.1 years, p=0.032), had a higher incidence of diabetes (27% vs. 8%, p=0.013), and more had fibrosis Stage 3 and cirrhosis (77% vs. 38%, p=0.0009). In addition, their pre-antiviral treatment alpha-fetoprotein (AFP) levels were higher (109.9ng/ml vs. 78.6ng/ml, p=0.016) and more were anti-HBc positive (65% vs. 29%, p=0.006). Eight of 22 (36%) patients developed HCC 4 to 10 years after SVR, while another seven (32%) developed HCC 10 years after SVR. The longest duration from SVR to HCC was 18.7 years. By multivariate analysis, independent factors associated with HCC development were anti-HBc positivity (hazard ratio [HR] 5.57, 95% CI 1.45-21.39, p=0.012), age at SVR (HR 1.08, 95% CI 1.02-1.14, p=0.014), higher pre-antiviral treatment AFP levels (HR 1.01, 95% CI 1.00-1.02, p=0.01), and Hispanic compared to Caucasian patients (HR 12.9, 95% CI 2.54-65.49, p=0.082). The risk for HCC was significantly less in genotype 2 (HR 0.2, 95% CI 0.05-0.78, p=0.02) compared to genotype 1 patients, and in those with higher pre-antiviral treatment albumin levels (HR 0.33, 95% CI 0.10-1.09 p=0.04).
The risk for HCC still exists in a subset of CHC patients after SVR and may occur up to 18 years after viral clearance. Therefore, indefinite HCC surveillance may be necessary in SVR patients with other risk factors.