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The following is a summary of “Long-term risk of HCC in a DAA-treated national hepatitis C cohort, and a proposed risk score,” published in the September 2024 issue of Infectious Disease by Lybeck et al. 

Patients with cirrhosis and hepatitis C who achieve sustained virological response (SVR) after direct-acting antiviral (DAA) treatment still have an increased risk of hepatocellular carcinoma (HCC).  

Researchers conducted a retrospective study to assess long-term HCC risk stratified by pretreatment liver stiffness measurement (LSM) and develop a risk score algorithm.  

They examined 7,227 DAA-treated patients with SVR to evaluate annual and cumulative HCC incidence rates (IRs) stratified by pretreatment LSM and analyzed the association between LSM and HCC risk using multivariate Cox regression. A risk score algorithm was developed and internally validated it in 2,664 individuals with LSM >9.5 kPa, assigning each patient a score based on risk factors and their associated HCC risk.  

The results showed a median follow-up of 1.8 years (3.2 years for LSM ≥12.5 kPa), with 92 patients (1.3%) developing HCC. The IRs for LSM 9.5–12.4, 12.5–19.9, and ≥20 kPa were 0.21, 0.99, and 2.20 HCC/100 PY, respectively, with no significant risk reduction during follow-up. The HRs (and 95% CI) for LSM 9.5–12.5, 12.5–19.9, and ≥20 kPa were 1.19 (0.43–3.28), 4.66 (2.17–10.01), and 10.53 (5.26–21.08), respectively. Risk score models including FIB-4, alcohol, diabetes, age, and LSM effectively stratified patients with LSM >9.5 kPa into low-, intermediate-, and high-risk groups (Harrell’s C of 0.799). Notably, 48% with LSM ≥9.5 kPa and 27% ≥12.5 kPa were classified as low risk. 

They concluded pretreatment LSM is associated with HCC risk, which remains stable during the initial 5 years post-SVR. The HCC risk score algorithm effectively identifies low-risk patients who may not require HCC surveillance. 

Source: tandfonline.com/doi/full/10.1080/23744235.2024.2403703#abstract