The risk of hepatocellular carcinoma is reduced but not eradicated among patients with hepatitis C virus (HCV)-induced advanced hepatic fibrosis who attained sustained viral response.
Dr Adriaan van der Meer and colleagues assessed the risk of cirrhosis-related complications in this specific group of patients.
Data from previously reported Western cohort studies including patients with chronic HCV infection and bridging fibrosis or cirrhosis who attained sustained viral response were pooled for survival analyses on the individual patient level.
The team's primary endpoint was hepatocellular carcinoma, and the secondary endpoint was clinical disease progression, defined as liver failure, hepatocellular carcinoma or death.
The research team included 1000 patients with sustained viral response, with a median age of 57 years, 68% were were male, and 85% had cirrhosis.
|The cumulative 8-year HCC incidence was 9% among those with cirrhosis|
|Alimentary Pharmacology & Therapeutics|
Median follow-up was 6 years.
The researchers reported that 51 patients developed hepatocellular carcinoma, and 101 had clinical disease progression.
The cumulative 8-year HCC incidence was 1.8 among patients with bridging fibrosis, and 9% among those with cirrhosis.
Within the cirrhosis group, the researchers found that 8-year hepatocellular carcinoma incidence was 3% among patients <45 years, 10% among patients from 45–60 years, and 12% among patients >60 years of age at start of therapy.
The research team indicated that higher age, lower platelet count and diabetes mellitus were independently associated with development of hepatocellular carcinoma.
The team observed that after 8 years 4% of patients with bridging fibrosis and 16% of patients with cirrhosis experienced clinical disease progression.
Dr van der Meer's team commented, "Patients with HCV-induced cirrhosis and sustained viral response showed an annual risk of approximately 1% for hepatocellular carcinoma, and 2% for clinical disease progression."
"Therefore, to prevent hepatocellular carcinoma surveillance, chronic HCV infection should preferably be treated before cirrhosis has developed."