Hepatocellular carcinoma risk in hepatitis C stage‐3 fibrosis after sustained virological response with direct‐acting antivirals

Autor:	Irene M García-Amengual, Pablo Ryan, María L García-Buey, Luz Martín-Carbonero, Maria Luisa Manzano, Leticia González-Moreno, María Laura Gutiérrez, Marian Garcia-Mayor, Inmaculada Fernández, Federico Pulido, Conrado M. Fernández-Rodríguez, Antonio Guerrero, F. Gea, Miguel Rivero-Fernández, María Sánchez-Azofra, Lourdes Domínguez-Domínguez, Maria Elena Portales, Antonio Olveira, Antonio Díaz-Sánchez, María Luisa Montes, Antonio Mancebo, Guillermo Cuevas, José María Moreno, Lucia Bonet, P. Castillo
Rok vydání:	2021
Předmět:	Liver Cirrhosis Male medicine.medical_specialty Carcinoma Hepatocellular Sustained Virologic Response Antiviral Agents Gastroenterology Fibrosis Internal medicine Ascites medicine Humans Hepatology business.industry Incidence (epidemiology) Liver Neoplasms Hazard ratio Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Hepatocellular carcinoma Cohort medicine.symptom Transient elastography business
Zdroj:	Liver International. 41:2885-2891
ISSN:	1478-3231 1478-3223
DOI:	10.1111/liv.15032
Popis:	BACKGROUND & AIMS Patients with chronic hepatitis C and stage 3 fibrosis are thought to remain at risk of hepatocellular carcinoma after sustained virological response. We investigated this risk in a large cohort of patients with well-defined stage 3 fibrosis. METHODS We performed a multicentre, ambispective, observational study of chronic hepatitis C patients with sustained virological response after treatment with direct-acting antivirals started between January and December 2015. Baseline stage 3 was defined in a two-step procedure: we selected patients with transient elastography values of 9.5-14.5 kPa and subsequently excluded those with nodular liver surface, splenomegaly, ascites or collaterals on imaging, thrombopenia or esophago-gastric varices. Patients were screened twice-yearly using ultrasound. RESULTS The final sample comprised 506 patients (median age, 57.4 years; males, 59.9%; diabetes, 17.2%; overweight, 44.1%; genotype 3, 8.9%; HIV coinfection, 18.4%; altered liver values, 15.2%). Median follow-up was 33.7 (22.1-39.1) months. Five hepatocellular carcinomas and 1 cholangiocarcinoma were detected after a median of 29.4 months (95% CI: 26.8-39.3), with an incidence of 0.47/100 patients/year (95% CI: 0.17-1.01). In the multivariate analysis, only males older than 55 years had a significant higher risk (hazard ratio 7.2 [95% CI: 1.2-41.7; P = .029]) with an incidence of 1.1/100 patients/year (95% CI: 0.3-2.8). CONCLUSIONS In a large, well-defined cohort of patients with baseline hepatitis C stage-3 fibrosis, the incidence of primary liver tumours was low after sustained virological response and far from the threshold for cost-effectiveness of screening, except in males older than 55 years.
Databáze:	OpenAIRE
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