Author information
1
Liver Center, Huntington Medical Research Institutes, Pasadena, California.
2
Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
3
Hospital Federal Dos Servidores do Estado, Rio de Janeiro, Brazil.
Abstract
BACKGROUND & AIMS:
Successful eradication of chronic hepatitis C (CHC) infection decreases the incidence of hepatocellular carcinoma (HCC), but a risk remains. We investigated factors associated with HCC development in CHC patients who had sustained virologic response (SVR) after antiviral therapies.
METHODS:
We retrospectively compared CHC patients achieving SVR to antiviral treatments between 1996 and 2016 who did and did not develop HCC. Their median follow-up period was 8.01 years.
RESULTS:
Compared to 164 non-HCC SVR patients, 22 who developed HCC were older in age at SVR (59 vs. 52.1 years, p=0.032), had a higher incidence of diabetes (27% vs. 8%, p=0.013), and more had fibrosis Stage 3 and cirrhosis (77% vs. 38%, p=0.0009). In addition, their pre-antiviral treatment alpha-fetoprotein (AFP) levels were higher (109.9ng/ml vs. 78.6ng/ml, p=0.016) and more were anti-HBc positive (65% vs. 29%, p=0.006). Eight of 22 (36%) patients developed HCC 4 to 10 years after SVR, while another seven (32%) developed HCC 10 years after SVR. The longest duration from SVR to HCC was 18.7 years. By multivariate analysis, independent factors associated with HCC development were anti-HBc positivity (hazard ratio [HR] 5.57, 95% CI 1.45-21.39, p=0.012), age at SVR (HR 1.08, 95% CI 1.02-1.14, p=0.014), higher pre-antiviral treatment AFP levels (HR 1.01, 95% CI 1.00-1.02, p=0.01), and Hispanic compared to Caucasian patients (HR 12.9, 95% CI 2.54-65.49, p=0.082). The risk for HCC was significantly less in genotype 2 (HR 0.2, 95% CI 0.05-0.78, p=0.02) compared to genotype 1 patients, and in those with higher pre-antiviral treatment albumin levels (HR 0.33, 95% CI 0.10-1.09 p=0.04).
CONCLUSIONS:
The risk for HCC still exists in a subset of CHC patients after SVR and may occur up to 18 years after viral clearance. Therefore, indefinite HCC surveillance may be necessary in SVR patients with other risk factors.