Predictors of hepatocellular carcinoma in HCV cirrhotic patients treated with direct acting antivirals |
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| Authors: | Ana Lleo Andrea Aglitti Alessio Aghemo Patrick Maisonneuve Savino Bruno Marcello Persico |
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| Affiliation: | 5. Gastroenterology and Digestive Endoscopy, University of Bari, Bari, Italy;6. Gastroenterology, University of Torino, Turin, Italy;7. Gastroenterology and Hepatology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy;8. Hepatology, University Hospital of Pisa, Pisa, Italy;9. Internal Medicine, University of Pisa, Pisa, Italy;10. Gastroenterology, University of Palermo, Palermo, Italy;11. Internal Medicine, San Paolo Hospital, Milano, Italy;12. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy;13. University of Modena and Reggio Emilia, Modena, Italy;14. Ospedale Fatebenefratelli e Oftalmico, Milano, Italy;15. Center for Translational Research in Hepatology, Humanitas Clinical and Research Center, Milan, Italy;p. Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy;1. Humanitas University, Department of Biomedical Sciences, Milan, Italy;2. Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy;3. Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy;4. Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy |
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| Abstract: | BackgroundDespite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs), the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial.AimTo prospectively assess the risk of HCC occurrence and early recurrence in a large cohort of DAA-treated HCV-cirrhotic patients and to identify potential predictors of HCC development.MethodsWe analyzed data prospectively collected from 1927 consecutive HCV-infected cirrhotic patients treated with DAA from January to December 2015 in 10 tertiary liver centers in Italy and followed-up for one year after therapy. 161 patients had a previous HCC.Results38/161 subjects developed tumor recurrence during the follow-up (recurrence rate?=?24.8 per 100-year), patients with SVR had a significantly lower rate of recurrence. Lack of SVR and alpha-fetoprotein (AFP) were independent predictors of HCC recurrence. 50/1766 patients without a previous HCC history developed HCC during follow-up (incidence rate?=?2.4 per 100-year). Lack of SVR was the strongest predictor of HCC development. Furthermore, patients with SVR and no stigmata of portal hypertension have a lower incidence rate of HCC (1.0 per 100-year).ConclusionsSVR is associated with a significant decrease of recurrent or de novo HCC. Baseline AFP and signs of portal hypertension can help to stratify the risk of HCC. |
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| Keywords: | Cirrhosis Direct antiviral agents HCV Hepatocellular carcinoma |
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