Biochemical predictors of hepatocellular cancer development after one year in patients who achieved HCV clearance by direct-acting antiviral treatment.

Abstract

The continued risk of hepatocellular cancer (HCC) following HCV clearance by direct-acting antivirals (DAAs), even if a sustained viral response (SVR) is achieved, has been previously reported. This study's objective was to identify biochemical predictors for HCC occurrence in patients who achieved HCV clearance by DAA treatment after one year. Patients who achieved SVR at week 24 with DAA between November 2015 and January 2021 and had no evidence of HCC were evaluated retrospectively. Biochemical parameters such as serum AFP (Alpha-fetoprotein), AST (Aspartate Aminotransferase), ALT (Alanine aminotransferase), albumin, PLT (platelet) count, FIB-4 and APRI indexes (non-invasive fibrosis indexes) were analyzed before starting the DAA treatment, at the end of the treatment (EOT), and 24th-week post-treatment. Throughout a median follow-up time of 43±16.2 months, it was observed that HCC occurred in 14 (5.6%) of 248 CHC patients who reached SVR at the 24th week after DAA treatment. According to multivariate analysis, AFP levels were >7.08 ng/ml before treatment (HR, 3.8; p=0.050), >5.15 ng/ml at the EOT (HR, 6.8; p=0.019), and >5.68 ng/ml at the 24th week post-treatment (HR, 21.2; p=0.002); albumin levels were <3.75 g/dl before treatment (HR, 3.6; p=0.042), <4.05 g/dl at the EOT (HR, 6.9; p=0.005), and <4.15 g/dl at week 24 post-treatment (HR, 8.8; p=0.002); PLT counts <153.000/mm3 at the 24th week post-treatment (HR, 12.1; p=0.001) were determined to be independent biochemical predictors for the development of HCC after one year of ending DAA treatment. AFP and albumin levels before treatment, at the EOT, and post-treatment at week 24, and PLT numbers at week 24 post-treatment can be used to foresee the risk of developing HCC one year after ending of DAA treatment.