HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta-analysis

Hepatitis C virus (HCV), a hepatotropic RNA virus, is one of the leading causes of chronic liver disease. HCC is a major complication associated with HCV virus infection, with significant mortality and morbidity rates. The goals for treating persons with chronic hepatitis C virus (HCV) are threefold: eradicate HCV, improve HCV-related health outcomes and survival in all populations, and reduce transmission of HCV to others. Direct-acting antiviral agents have emerged as promising treatment options and are associated with high sustained virological response rate. Despite the advent of highly effective treatment, the morbidity and incidence of HCV-related HCC remains high. Indeed, the residual risk of HCC, which is diminished but not entirely removed by viral eradication, dramatically influences how liver disease is managed going forward after HCV successful treatment. Identifying whether patients require continuous HCC surveillance as the proportion of patients with HCV cure increases is critical and lifelong surveillance for HCC in patients with fibrosis is associated with considerable economic and psychological implications.. Currently, it is unclear if HCC risk decreases over time after HCV cure and whether individuals with cirrhosis can ever safely stop being monitored.

To answer whether surveillance following HCV cure should be advised for all patients with F3 fibrosis or only for those identified as being at high risk, Australian researchers from the University of New South Wales, Ian Lockart, Malcolm Yeo, Dr. Behzad Hajarizadeh, Gregory Dore and Professor Mark Danta assessed the frequency of de novo HCC among patients with F3 fibrosis or cirrhosis. They conducted a meta-regression analysis to find study-level variables linked to the risk of HCC. The new study is now published in the research journal Hepatology,

The research team findings provided an estimate of HCC incidence among patients with cirrhosis and F3 fibrosis following HCV cure. The authors found that the chance of developing HCC decreased with each additional year of follow-up among individuals with cirrhosis who had been cured of HCV. Their findings raises the possibility that some cirrhotic patients may eventually transition to a less rigorous surveillance regimen after HCV treatment. An important criteria in this current study is the well-defined study populations which allowed for an accurate estimation of HCC incidence among patients with F3 fibrosis or cirrhosis after HCV cure.

In a nutshell, according to the authors, after HCV is cured, the incidence of HCC among patients with cirrhosis declines over time and is lowest in individuals who are younger in age and have compensated cirrhosis. The F3 fibrosis incidence is significantly lower than recommended for cost-effective screening. Their findings should stimulate the development of validated predictive algorithms that more accurately pinpoint those who are at risk, particularly in patients with F3 fibrosis.