Role of liver stiffness measurements in patients who develop hepatocellular carcinoma after clearance of the hepatitis C virus

Yoshinori Gyotoku,Toshikuni Suda,Masaya Tamano,Ryosaku Shirahashi

doi:10.1007/s10396-021-01188-x

Abstract

PurposeTo measure changes in liver stiffness over time due to direct-acting antiviral (DAA) therapy in hepatitis C patients using shear wave elastography (SWE).MethodsPatients with hepatitis C treated with DAA therapy in a university medical center between July 2015 and April 2020 were evaluated. Shear wave velocity (Vs) of the liver was measured using SWE. Alanine aminotransferase (ALT), platelet count, and α-fetoprotein (AFP) were measured at the same time, and the FIB-4 index was estimated. Absence of hepatocellular carcinoma was confirmed at baseline and end of therapy. Imaging was then performed every 6 months. Patient characteristics were compared between patients who did and did not develop carcinoma.ResultsThe mean age of the 229 patients (93 men) was 65.6 years. Eight patients developed carcinoma during follow-up (mean 32.6 ± 19.5 months). Significant differences were found between the groups in terms of AFP, platelet count, and Fib-4 index at baseline; the pre-treatment data had the best relationship with hepatocarcinogenesis. Mean Vs decreased significantly during DAA therapy, and then decreased further. Liver stiffness 6 months after treatment ended had the best relationship with hepatocarcinogenesis.ConclusionIn patients with a sustained virological response, risk of developing cancer can be predicted by measuring Vs approximately 6 months after treatment.

Highlights

Significant advances have been made in the treatment of hepatitis C with the advent of direct-acting antiviral agents (DAAs)
A total of 355 patients with hepatitis C were recruited for the study
After excluding 21 patients for whom velocity of shear waves (Vs) was not measured all three times, 14 patients lost to followup, and 91 patients for whom the observation period was less than 6 months, the investigation included 229 cases (Fig. 1)

Summary

Introduction

Significant advances have been made in the treatment of hepatitis C with the advent of direct-acting antiviral agents (DAAs). DAA therapy has milder side effects than IFN therapy, and there is a high rate of sustained virological response (SVR) [1,2,3,4,5]. When SVR is achieved with DAA therapy, cancer inhibition similar to that with IFN therapy is seen [6,7,8]. High ALT and AFP values and low platelet counts are reported to be risk factors for cancer after SVR [9], but they are analyzed based on pre- and post-treatment clinical data. We see many patients in whom SVR was achieved with DAA therapy at other institutions.

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Conclusion