Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy.
Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy.
Department of Clinical Medicine, Gastroenterology Unit, Sapienza University of Rome, Rome, Italy.
Gastroenterology Unit, Catholic University of Rome, Rome, Italy.
Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
Internal Medicine, Gastroenterology and Hepatology, A. Gemelli Hospital, Rome, Italy.
Department of Infectious Disease, Tor Vergata University Hospital, Rome, Italy.
Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy.
Risk of HCC in HCV cirrhotic patients treated with DAA is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow up of 17.3 months after EOT, including 943 patients without history of HCC and 102 previously treated for HCC. The majority were males (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan Meier curves were performed to detect predictors of HCC in patients with and without reduction in AFP during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54/943 (5.7%) occurrent and 41/102 (39%) recurrent tumors. De-novo were more often unifocal (p=0.01) and curable (p=0.03). AFP decreased from 16.1 ± 36.2 mg/dl (baseline) to 11.4 ± 55 mg/dl (EOT). At univariate analysis, predictors were a previous HCC, older age, higher MELD, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction of AFP during treatment. Kaplan Meier curves showed lower incidence of HCC in patients showing any reduction of AFP (p=0.001). Those with AFP <6 ng/ml had the lowest risk (p=0.0002). At logistic regression, platelets (p=0.009, OR 0.99 CI: 0.99-1.00), previous HCC (p<0.00001, OR: 10.76, 95% CI: 5.89-19.34), and no reduction of AFP during treatment (p=0.0005, OR: 2.98, CI: 1.60-5.54) were independent predictors of HCC. In conlusion, risk of HCC after DAA treatment remains substantial. It's higher among patients with previous HCC, low platelets and without reduction of AFP during treatment.