1045 BMI Is an Independent Predictor for the Occurrence of HCC Following DAA Therapy in HCV Related Cirrhosis

Abstract

INTRODUCTION: Treatment for Hepatitis C Virus (HCV) has made a significant stride with the advent of direct-acting antiviral (DAA) therapy with SVR rates higher than 95%. Despite such a big feat, questions have been raised regarding the rate of occurrence and recurrence of HCC following treatment with DAA, especially in those with cirrhosis. METHODS: Using our database, we first identified all patients with liver cirrhosis secondary to HCV with no prior history of HCC, who were treated with DAA between 01/01/2014 to 04/01/2018 at our institution. We then performed a detailed review of their electronic medical records and obtained relevant clinical data. Patients who developed HCC in the follow-up period were identified. HCC screening was carried out every 3-6 months with US or CT abdomen. Categorical variables were calculated as frequencies(percentages), and continuous variables were calculated as median (range). Cumulative incidence of de novo HCC was calculated using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis was performed to identify predictors for the development of HCC. RESULTS: We identified 254 patients meeting the criteria mentioned above. The basic demographics and key variables were identified and computed for those with and without the occurrence of HCC, as shown in Table 1. The two groups were quite similar in terms of the different variables that were studied. The patients had a median follow up of 21 months (3-55 months) following the start of DAA therapy. Sixteen patients subsequently developed de novo HCC with an occurrence rate of 6.3%. The cumulative incidence of HCC at 1,2 and 3 years of follow up are 1.6%, 6.6 %, and 11.3 %, respectively (Figure 1). Univariate analysis revealed a higher BMI of > 30, was statistically significant (P value = 0.047) for an association with the occurrence of HCC ( HR of 4.06 with a CI of 0.9-18.19) (Figure 2). The median time to the occurrence of HCC following DAA therapy was 17 months. Multivariate analysis was performed to analyze the interaction between different variables on HCC occurrence, namely BMI, CHILD class, AFP, and Viral load, which did not reveal any significant association. CONCLUSION: Of the various risk factors that have been identified for de novo HCC occurrence, our study identified higher BMI as an independent risk factor for HCC occurrence. Further large-scale prospective studies should be performed to identify and confirm these risk factors associated with increased HCC occurrence.