Year 2024 / Volume 116 / Number 6
Original
Screening and risk of hepatocellular carcinoma in patients with advanced fibrosis after hepatitis C virus eradication

305-311

DOI: 10.17235/reed.2024.9945/2023

Silvia Espina Cadena, Diego Casas Deza, Belén Julián Gomara, Cristina Victoria Borao Laguna, Olivia Sierra Gabarda, Luis Javier Lamuela Calvo, Sara Lorente, Trinidad Serrano, José Miguel Arbonés Mainar, Vanesa Bernal Monterde,

Abstract
Introduction: the risk of hepatocellular carcinoma (HCC) after eradication of the hepatitis C virus (HCV) is highly variable in patients with advanced fibrosis (F3). Long-term surveillance for HCC after sustained virological response (SVR) is controversial in these patients. The objective of this study was to describe the post-SVR follow-up in clinical practice in patients with F3 and determine the predictive factors for the development of HCC. Patients and methods: a multicenter, observational and retrospective study was performed, which included HCV-monoinfected patients with F3 fibrosis determined by transient elastography who achieved SVR between 2015 and 2022, with follow-up until May 2023. Clinical-demographic, laboratory, elastography, and ultrasound variables were recorded before and after treatment. A descriptive and inferential analysis, Cox regression analysis and survival analysis were carried out with the R statistical software. Results: two hundred and nineteen patients were included in the study (65.3 % males, median age 57 years), and 175 (79.9 %) received ultrasound screening after SVR for 62 (6-90) months. The prescribing service was the only independent variable related to performing ultrasound surveillance (p = 0.004). Eight patients developed HCC. In multivariate analysis adjusted for sex, age, presence of diabetes and alcohol consumption, a post-SVR FIB-4 ≥ 3.25 was associated with a 12-fold increase in HCC risk. The cumulative probability of HCC was higher in the group of patients with FIB-4 ≥ 3.25 after SVR (p < 0.001). Conclusion: post-SVR follow-up of patients with F3 fibrosis is variable in clinical practice. Using the FIB-4 after SVR allows us to identify those patients with a higher risk of HCC who benefit from biannual ultrasound screening.
Lay Summary
The risk of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication in individuals with advanced fibrosis (F3) is variable. Therefore, risk factors that identify patients in whom HCC screening is cost-effective after sustained virological response (SVR) are currently being investigated. The objective of our study was to describe the follow-up after HCV eradication in patients with F3 stage and to determinate the predictive factors for the development of HCC. For this purpose, an observational, retrospective, and multicenter study was carried out with all the 8 reference hospitals of the autonomous community of Aragon, Spain. Patients with HCV and F3 fibrosis stage by vibration-controlled transient elastography treated with direct-acting antivirals (DAA) were included. Clinical-demographic, analytical, elastography and sonographic variables were collected, before and after antiviral treatment. A total of 219 patients were included, of which 79.9% received follow-up with biannual abdominal ultrasound after SVR. The only variable associated with surveillance was the service prescribing antiviral therapy. During follow-up, 8 patients developed HCC. In the multivariate analysis, the presence of a FIB-4 index ≥ 3.25 after DAA was associated with a 12-fold increased risk of HCC. Furthermore, in the survival analysis, the cumulative probability of HCC was higher in patients with a FIB-4 index ≥ 3.25 after treatment. Therefore, the use of this index during surveillance after SVR could be a tool to identify those individuals at higher risk of HCC.
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Espina Cadena S, Casas Deza D, Julián Gomara B, Borao Laguna C, Sierra Gabarda O, Lamuela Calvo L, et all. Screening and risk of hepatocellular carcinoma in patients with advanced fibrosis after hepatitis C virus eradication. 9945/2023


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Publication history

Received: 07/09/2023

Accepted: 12/12/2023

Online First: 11/01/2024

Published: 04/06/2024

Article revision time: 80 days

Article Online First time: 126 days

Article editing time: 271 days


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