Journal of Hepatocellular Carcinoma (Aug 2021)
Decreased Incidence of Hepatocellular Carcinoma after Directly Acting Antiviral Therapy in Patients with Hepatitis C–Related Advanced Fibrosis and Cirrhosis
Abstract
Shimaa Kilany,1 Lmyaa Ata,1 Asmaa Gomaa,1 Aliaa Sabry,1 Ali Nada,1 El-Sayed Tharwa,1 Gamal Badra,1 Ashraf Abogabal,1 Mohamed Elwaraky,2 Enas Moaz,3 Sameera Ezzat,3 Ahmed Elsharawy,4 Imam Waked1 1Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt; 2Radiology Department, National Liver Institute, Menoufia University, Menoufia, Egypt; 3Epidemiology Department, National Liver Institute, Menoufia University, Menoufia, Egypt; 4Clinical Pathology Department, National Liver Institute, Menoufia University, Menoufia, EgyptCorrespondence: Imam WakedNational Liver Institute, Menoufia University, Shebeen El-Kom, Menoufia, EgyptTel +20-12-2215-7256Fax +20-48-2234586Email [email protected] and Aim: Existing data are controversial regarding the incidence of hepatitis C (HCV)–related hepatocellular carcinoma (HCC) following directly acting antiviral (DAA) therapy. This prospective study aimed to assess incidence, and risk factorss of HCC following DAA therapy in patients with HCV-related advanced fibrosis (F3) and cirrhosis (F4).Methods: Incidence of HCC was calculated in 1,630 patients with HCV-related F3 and F4 treated with DAA prospectively followed for up to 43 months in a single tertiary referral center and compared to historical controls. Risk factors of incident HCC were also determined.Results: The crude outcome rate was 2.15/100 person-years, significantly lower than a similar historical cohort (5.57/100 person-years). Risk of developing HCC was higher with the presence of cirrhosis (F4 vs F3, AHR 3.59) and treatment failure (vs achieving SVR, AHR 3.37). Presence of decompensated cirrhosis, platelet count < 100× 103/mL, and high AFP were independent risk factors of developing HCC.Conclusion: Incidence of HCC was significantly lower in patients with HCV-related advanced fibrosis and cirrhosis treated with DAAs than in a historical cohort of untreated patients. Decompensated cirrhosis, baseline AFP ≥ 10 ng/mL, diabetes, and nonresponse to DAA were independent risk factors of incident HCC.Keywords: HCC, DAA, HCC incidence, HCC predictors, HCC characteristics