S1053 Risk of Hepatocellular Carcinoma in Hepatitis C Cirrhotic Patients After Successful Direct Antiviral Agents Therapy

Abstract

INTRODUCTION: The risk of hepatocellular carcinoma (HCC) associated with chronic hepatitis C infection (HCV) remains a relevant issue in clinical practice. With the direct antiviral agents (DAA) therapy it was expected an indeed strikingly decrease of HCC after sustained virological response (SVR). However, studies have shown discordant results regarding the incidence of HCC in patients with cirrhosis and SVR. Thereby, the aim of the present study was to determine the risk of HCC in a cohort of patients with HCV-related cirrhosis after viral eradication with DAA. METHODS: We collected data retrospectively from HCV patients with liver cirrhosis treated with DAA between January 2015 and December 2019. Individuals with regular compliance to screening program according to EASL guidelines were included in the study. Patients with a previous diagnosis of HCC, non-characterized nodules or without SVR were excluded. RESULTS: A total of 139 cirrhotic patients were included. DAA therapy induced SVR in 92,7% of individuals. Most patients were males (70,5%), with a median age of 56 years old (IQR 52-63) and with prevalent HCV genotype 1 infection (73,4%). In what concerns to severity of liver disease, 105 patients (75,5%) were classified as Child-Pugh class A at the start of DAA therapy. Measurement of liver stiffness (LS) by transient elastography resulted in a median kPa value of 23 (IQR 15-32). The most used treatment regimens were Ledipasvir (LDV)/Sofosbuvir (SOF) (52,5%), LDV/SOF/Ribavirin (16,5%), SOF/Velpatasvir (9,4%) and Elbasvir/Grazoprevir (7,9%). There was a significant decline in LS after antivirals therapy (P < 0.001). HCC was detected in 15 patients (10,8%), within a mean time of 21 months after treatment completion. HCC developed in 7 patients during the first 24 months after finishing antivirals (incidence rate 5,0%) and in additional 8 individuals at longer follow-up (incidence rate 6,1%). 9 patients died, secondary to complications of liver failure (n = 4) or extrahepatic diseases (n = 5). CONCLUSION: DAA are able to eradicate HCV infection in most patients with cirrhosis. Moreover, LS decreases significantly after antiviral treatment. However, the occurrence of HCC is not abolished in effectively treated cirrhotic patients. In fact, HCC may develop not only in the initial period after treatment completion, but there is still a risk of liver cancer later in the follow-up. For these reasons, all cirrhotic patients should be closely monitored and followed after antiviral therapy.Table 1.: Characteristics of hepatitis C infection-related cirrhotic patients who achieved sustained virological response after direct antiviral agents therapy. IQR - interquartile range, LDV – Ledipasvir, SOF – Sofosbuvir, RBV – Ribavirin, VEL – Velpatasvir, EBR – Elbasvir, GRZ – Grazoprevir, GLE – Glecaprevir, PIB – Pibrentasvir, PrOD - Paritaprevir/Ritonavir/Ombitasvir with Dasabuvir