predictor of hepatocellular carcinoma (HCC) Varies in virologicly cured patients Hepatitis C Viral (HCV) infection with and without cirrhosis, according to studies. However, changes in fibrosis-4 (FIB-4) scores over time are associated with his HCC risk in both cohorts.
“[O]Your study provides evidence from a well-characterized cohort of HCV patients who are virologically cured but without cirrhosis, and monitoring changes in FIB-4 is particularly useful for diabetes and hypertension. It may be clinically useful in patients who have “In patients with cirrhosis, the evolution of FIB-4 and other selectable markers of liver disease severity may improve risk stratification.”
A retrospective cohort study was conducted in HCV patients who achieved a durable virologic response to direct-acting antivirals from 130 veterans’ hospitals from 2014 to 2018 through 2021.
The investigators conducted three landmark time points (baseline and 12 and 24 months after a sustained virologic response) to generate a Cox proportional hazards model.
A total of 92,567 patients were included, 32% of whom had cirrhosis, and 3,247 HCC cases were diagnosed during a mean follow-up of 2.5 years. [Am J Gastroenterol 2022;117:1834-1844]
In patients with cirrhosis, the following factors correlated with HCC risk at each landmark time point: [HRs]1.89, 1.93, and 1.99), duration of cirrhosis >5 years (HR, 1.71, 1.79, and 1.34), varicose veins (HR, 1.73, 1.60, and 1.56), baseline albumin (HR, 0.48, 0.47, and 0.49), changes in albumin (HR, 0.82, and 0.90).
Similarly, HCV genotype 3, previous therapy, bilirubin, smoking, and race predicted HCC risk at baseline, but their associations weakened over time.
In patients without cirrhosis, diabetes (HR, 1.54, 1.42, and 1.47) and hypertension (HR, 1.59, 1.65, and 1.74) influenced HCC risk at all critical time points. Notably, changes in FIB-4 scores over time were significantly correlated with HCC risk in both patients with and without cirrhosis.
“Our study has three important findings. First, risk factors for HCC differed between patients with and without cirrhosis,” said the researchers. “Second, changes in some risk factors over time, particularly markers of liver fibrosis, may help predict risk in virologically cured HCV patients.”
“Third, our data support previous reports showing that HCC risk remains elevated in some patient groups after SVR,” they noted. [Gastroenterology 2017;153:996-1005;
Gastroenterology 2019;157:1264-1278; Hepatobiliary Pancreat Dis Int 2020;19:541-546;
J Hepatol 2018;69:1088-1098]
Furthermore, smoking was found to contribute to an increased risk of HCC in patients with cirrhosis. Previous studies have pointed to several components of tobacco smoke that promote hepatocarcinogenesis. [Liver Int 2018;38:1487-1494;
Int J Epidemiol 2009;38:1497-1511; J Epidemiol 2013;23:115-121;
J Hepatol 2011;54:753-759]
Low BMI and sarcopenia also contributed to increased risk of HCC, but the current study was unable to examine the exact mechanisms. [Clin Nutr 2020;39:3132-3139]
“Repeated-measures-based risk assessment at 2 years is actionable and helps patients and their physicians by providing a quantifiable, personalized HCC risk assessment, including how it changes over time. We believe that we can improve shared decision-making among people,” the researchers said.