Author information
1 Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
2 Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan. hirokoga@med.kurume-u.ac.jp.
3 Clinical Research Center, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan.
4 Division of Gastroenterology, National Kyusyu Medical Center Hospital, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, 810-8563, Japan.
5 Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
6 Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
7 Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
8 Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556, Japan.
9 Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hazama-machi, Yufu, 879-5593, Japan.
10 First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus, 207 Azauehara, Nishihara-machi, Nakagashira-gun, 903-0215, Japan.
11 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 850-0000, Japan.
12 Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, 890-8544, Kagoshima, Japan.
13 Department of Liver Disease, University of Miyazaki Hospital, 5200 Kihara, Kiyotake-machi, Miyazaki, 889-1692, Japan.
14 Fukuoka Tokushukai Medical Center, 4-5 Sugukita, Kasuga, 816-0864, Japan.
15 Department of Hepato-Biliary-Pancreatic Surgery and Clinical Research Institute, National Kyushu Medical Center Hospital, 1-8-1 Chigyouhama, Chuou-ku, Fukuoka, 810-8563, Japan.
16 Hepatology Division, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Minami-ku, Fukuoka, 815-8555, Japan.
17 Biostatistics Center, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan.
Abstract
BACKGROUND:
While achieving sustained virological response (SVR) following interferon-based or direct-acting antiviral agent (DAA) treatments reduces the incidence of hepatocellular carcinoma (HCC), an increase in unexpected early occurrence or recurrence of HCC after hepatitis C virus elimination by DAA treatments has been reported. We prospectively investigated the incidence and risk factors of HCC after DAA treatment in a large multicenter cohort in Japan.
METHODS:
Patients with chronic hepatitis C with or without cirrhosis who were treated with DAAs and obtained SVR were enrolled. DAAs were administered for 3 or 6 months. A total of 2552 patients were enrolled.
RESULTS:
Of these, 70 patients (2.7%) developed HCC. The 12-, 24-, and 36-month cumulative HCC incidences were 1.3%, 2.9%, and 4.9% in all patients; 2.5%, 5.2%, and 10.0% in those with cirrhosis; and 0.9%, 2.1%, and 2.9% in those without cirrhosis, respectively. Multivariate analysis revealed age, sex, gamma-glutamyl transpeptidase level, and fibrosis-4 index to be independent factors associated with HCC. Patients with these four factors had an approximately six-to-sevenfold increased risk for HCC development. Five patients with large and early tumor occurrence did not receive contrast imaging examinations before treatment.
CONCLUSION:
Although the results of our prospective study suggested that achieving SVR by DAA treatment reduces the incidence of HCC, HCC development still occurs. Careful follow-up is important in patients with risk factors.