Factors associated with hepatocellular carcinoma occurrence after HCV eradication in patients without cirrhosis or with compensated cirrhosis.

Kazumichi Abe,Jun Tojo,Manabu Hayashi,Hiroto Wakabayashi,Atsushi Takahashi,Hironobu Saito,Tomohiro Suzuki,Haruo Nakayama,Naoe Yoshida,Masashi Fujita,Atsuko Kogure,Hiromasa Ohira,Masahito Kuroda,Tsuyoshi Rai,Shinji Mukai,Ming-Lung Yu

doi:10.1371/journal.pone.0243473

Abstract

The present study aimed to investigate the incidence of hepatocellular carcinoma (HCC) and factors related to HCC occurrence after direct-acting antiviral (DAA) treatment in the Fukushima Liver Academic Group (FLAG). We conducted a multicenter retrospective cohort study of 1068 patients without cirrhosis (NC) or with compensated liver cirrhosis (LC) who achieved a sustained virologic response (SVR). First, we compared the cumulative HCC incidence and survival rates in NC (n = 880) and LC (n = 188) patients without a history of HCC treatment. Second, we performed multivariate analysis of factors related to HCC occurrence after DAA treatment. Overall, the average age was 65 years, and the male/female ratio was 511/557. Thirty-nine (4%) patients developed HCC. The cumulative 4-year HCC incidence and survival rates were 3.0% and 99.8% in NC patients and 11.5% and 98.5% in LC patients, respectively. The independent factors affecting HCC occurrence identified by multivariate analysis were the serum albumin (ALB) level before SVR for NC patients and the ALBI score, platelet count, and diabetes before SVR for LC patients. The factors related to HCC occurrence differed between NC and LC patients. Careful surveillance of post-SVR patients with these risk factors is needed.

Highlights

Multivariate analysis identified an ALBI score >-2.3 after direct-acting antiviral (DAA) treatment as an independent factor that contributed to the development of hepatocellular carcinoma (HCC) in patients with compensated cirrhosis (S7 and S8 Tables)
Several studies have analyzed the risk factors for HCC occurrence and the characteristics of HCC that occurs after sustained virologic response (SVR) in chronic hepatitis C patients treated with DAA compared with those treated with IFN-based treatments
Recent studies reported that male sex, increased FIB-4 scores, decreased ALB levels, older age, and increased AFP levels were independent risk factors identified by multivariate analysis [11,12,13]

Summary

Introduction

Eradication of hepatitis C virus (HCV) by successful antiviral treatment with direct-acting antivirals (DAAs) has been shown to significantly reduce the risk of hepatocellular carcinoma. Cosmos Clinic provided support in the form of salary for author JT. Predictors of HCC occurrence after DAA treatment in patients without a history of HCC treatment have not been clearly elucidated. Previous studies have demonstrated that factors evaluated at or shortly before the onset of antiviral treatment and at the end of antiviral treatment can be used to predict the occurrence of HCC after the initiation of treatment. We focused on using pretreatment data to evaluate the factors associated with HCC occurrence in post-SVR patients without cirrhosis or with compensated cirrhosis

Results

Discussion

Study design and patient population