Prior decompensation and older age increases HCC risk among cirrhosis patients after HCV infection

Australia: Following hepatitis C virus (HCV) treatment, the incidence of hepatocellular carcinoma (HCC) among patients with cirrhosis declines over time and is lowest in individuals who are younger and have compensated cirrhosis. However Prior decompensation and older age is linked to increased risk of HCC among cirrhosis patients.

The study has been published in the journal Hepatology.

Curing HCV lowers but does not completely eradicate the risk of HCC. In populations where the incidence surpasses 1.5 percent annually, HCC monitoring is advised. It is unclear if HCC surveillance in cirrhosis should remain indefinitely following HCV treatment. The suggestions in the guidelines are erratic for individuals with advanced fibrosis (F3). As a result, Ian Lockart and colleagues examined the prevalence of HCC among individuals with F3 fibrosis or cirrhosis following HCV cure.

In this systematic review and meta-analysis, 44 studies measuring the incidence of HCC among patients with F3 fibrosis or cirrhosis following HCV cure were found (107,548 person-years of follow-up).

The key findings of this study were as follows:

1. Patients with cirrhosis had an incidence of HCC of 2.1 per 100 person-years, whereas those with F3 fibrosis had an incidence of 0.5 per 100 person-years.

2. An increased risk of HCC was linked to older age and preceding decompensation in a meta-regression study of individuals with cirrhosis.

3. A lower incidence of HCC was linked to longer follow-up following HCV cure.

In conclusion, the Authors found that HCC incidence in cirrhosis warrants cost-effective screening, but it also suggests that the incidence is declining over time, being least in patients with compensated cirrhosis and younger age. The incidence of HCC is significantly lower and below suggested levels for widespread HCC screening in individuals with F3 fibrosis and HCV cure. It is obvious that a more accurate diagnosis of individuals at risk for HCC following HCV cure will have important consequences for cost-effectiveness and resource usage.

The findings should stimulate the creation of validated prediction algorithms that can more accurately pinpoint those who are at risk, particularly in patients with F3 fibrosis. These findings ought to promote collaboration in order to carry out a sizable multicenter cohort research evaluating HCC risk over time following HCV cure.

Reference:

Lockart, I., Yeo, M. G. H., Hajarizadeh, B., Dore, G. J., Danta, M., Abe, K., Carrat, F., Lusivika‐Nzinga, C., Degasperi, E., Di Marco, V., Hou, J., Howell, J., Janjua, N. Z., Lok, A. S., Wei, L., … Tsai, P. (2022). HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta‐analysis. In Hepatology (Vol. 76, Issue 1, pp. 139–154). Wiley. https://doi.org/10.1002/hep.32341