Abstract
Hepatitis C virus (HCV) infection is the main cause of hepatocellular carcinoma (HCC) in the United States (US) and an increasingly common cause of HCC in China. We aimed to evaluate the incidence and risk factors of HCC in HCV patients in the US and China. 795 HCV RNA + patients without HCC from University of Michigan Health System (UMHS) in the US and 854 from Peking University Health Sciences Center (PUHSC) in China were prospectively followed for a median of 3.2 and 4.0 years, respectively. 45.4% UMHS and 16.2% PUHSC patients had cirrhosis. 57.6% UMHS and 52.0% PUHSC patients achieved SVR. 45 UMHS and 13 PUHSC patients developed HCC. Cumulative incidence of HCC at 5 years was 7.6% in UMHS and 1.8% in PUHSC cohort (P < 0.001). Ten patients not diagnosed with cirrhosis at enrollment but median APRI ≥ 2.0 developed HCC. Multivariate analysis showed age, gender, cirrhosis and APRI were predictors of HCC while study site and SVR were not. In this study of HCV patients, HCC incidence in the PUHSC cohort was lower than in the UMHS cohort, due to lower proportion of PUHSC patients with cirrhosis. APRI can identify risk of HCC among patients not diagnosed to have cirrhosis.
Highlights
An estimated 71 million people have chronic hepatitis C virus (HCV) infection and approximately 399 000 people die from hepatitis C each year, primarily due to complications of cirrhosis and hepatocellular carcinoma (HCC)[1]
Our study sought to compare the incidence of HCC in University of Michigan Health System (UMHS) and Peking University Health Sciences Center (PUHSC) HCV cohorts and to identify the risk factors of HCC development
We found that HCC incidence in the PUHSC cohort was lower than in the UMHS cohort, mainly due to a lower proportion of PUHSC patients with cirrhosis
Summary
An estimated 71 million people have chronic hepatitis C virus (HCV) infection and approximately 399 000 people die from hepatitis C each year, primarily due to complications of cirrhosis and hepatocellular carcinoma (HCC)[1]. The prevalence of chronic HCV infection in the United States (US) is estimated to be 1.0–2.0%, affecting between 2.7–5.2 million people[2,3]. The prevalence of chronic HCV infection in China is estimated to be 1%, with approximately 10 million persons infected[4]. Due to the late introduction of and limited access to direct-acting antivirals (DAAs) in China, complications of HCV infection, including HCC, are expected to increase[8]. In 2011, we initiated a parallel cohort study of patients with chronic HCV infection in the US and in China to compare the incidence and risk factors of clinical outcomes. The current study utilized prospective longitudinal data in these two cohorts to compare the incidence of HCC and to study factors associated with HCC development
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