HCV: post-DAA HCC risk higher with advanced fibrosis

  • Piñero F & al.
  • Liver Int
  • 13 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Although HCV clearance with direct-acting antivirals (DAAs) significantly reduces risk for de novo hepatocellular carcinoma (HCC), the effect is attenuated in patients with advanced fibrosis.

Why this matters

  • Findings support guidelines for continued surveillance.

Study design

  • Prospective multicenter Latin American cohort study involving 1400 patients treated with HCV DAAs; 72.5% had F3-F4 fibrosis and 56.0% were cirrhotic.
  • Abdominal ultrasound was performed every 6 months.
  • Funding: Argentina National Institute of Cancer, and LALREAN (AbbVie, Bristol-Myers Squibb).   

Key results

  • 91.4% (n=1280) completed the DAA regimen.
  • Sustained virologic response (SVR) rate (n=1149 with data): 96.9%.
  • 30 HCC cases were diagnosed over a median 16 months from DAA initiation (median time to diagnosis, 7.9 months).
  • Cumulative HCC incidence overall and with cirrhosis:
    • 12 months: 2% (95% CI, 1%-3%) and 3% (95% CI, 2%-5%).
    • 24 months: 4% (95% CI, 3%-6%) and 6% (95% CI, 4%-8%).
  • Non-SVR was tied to an ~5-fold increased risk for HCC (HR=4.9; P=.011) after adjusting for diabetes, prior interferon failure, Child-Pugh stage, and clinically significant portal hypertension (CSPH).
  • CSPH was the strongest predictor of HCC (HR=9.1; P<.0001>
  • SVR reduced relative risk for HCC by 73% (95% CI, 15%-91%).
    • Persons needed to treat/case reduced: 17.

Limitations

  • Short follow-up.
  • Potential preexisting HCC not captured.