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Some people with liver cirrhosis remain at risk for developing hepatocellular carcinoma (HCC) even after hepatitis C treatment, according to study results presented at the AASLD Liver Meeting last November. Not achieving a cure was the biggest risk factor. A related study found that among people who were cured, HCC risk factors differed for people with and without cirrhosis.
People who are successfully treated for hepatitis C are less likely to develop HCC, but some risk remains, especially for those who have already progressed to advanced fibrosis or cirrhosis.
Italian researchers looked at 2214 people with hepatitis C and cirrhosis who were treated with direct-acting antivirals and followed for at least a year after being treated. Ninety-three per cent were cured of hepatitis C and after a median follow-up of 30 months, 6.7% developed HCC for the first time. The risk of developing HCC was seven times higher in people who were not cured of hepatitis C.
In people cured of hepatitis C, genotype 3 infection, low albumin level and older age were independent risk factors for developing HCC.
In a second study, of 98,612 US military veterans treated for hepatitis C, annual HCC incidence rates for people with cirrhosis were 1.6% during the first year post-treatment and 1.9% during the second year, compared with 0.21% and 0.27%, respectively, for those without cirrhosis.
The researchers found that liver cancer risk factors differed based on cirrhosis status. Among people with cirrhosis, HCC predictors at 12 months included male sex, White race, HCV genotype 3, longer cirrhosis duration, higher bilirubin levels and the presence of oesophageal varices. Changes in albumin levels and worsening fibrosis (as indicated by FIB-4 score) also predicted HCC risk. However, race, HCV genotype and bilirubin were no longer significant predictors at 24 months while changes in haemoglobin level became a significant factor. Non-smokers had a lower HCC risk.
Among people without cirrhosis, metabolic factors such as diabetes and hypertension, as well as worsening fibrosis, were strongly associated with HCC risk at both time points.
These findings could inform decisions about HCC surveillance in people cured of hepatitis C, say the US researchers. Because risk factors can change over time, they suggested that repeated assessment at two years "is practical and can improve risk stratification" in patients cured of hepatitis C, regardless of their cirrhosis status.
HCC after sustained virological response has been observed in past studies in people with cirrhosis. The EASL guidelines for HCC (2018) recommend screening patients with cirrhosis for HCC every six months.
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