Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 14;3(3):100289.
doi: 10.1016/j.jhepr.2021.100289. eCollection 2021 Jun.

Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness

Elton Dajti  1   2 , Giovanni Marasco  1   2 , Federico Ravaioli  1   2 , Luigi Colecchia  1   2 , Alberto Ferrarese  3 , Davide Festi  2 , Antonio Colecchia  3
Affiliations

Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness

Elton Dajti et al. JHEP Rep. .

Abstract

Background & aims: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs.

Methods: This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development.

Results: During a median follow-up of 41.5 (IQR 32-49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001-1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 ≤10 kPa were at the lowest risk of HCC. In patients with LSM-SVR24 >10 kPa, HCC incidence was not further influenced by LSM values (10-20 kPa vs. >20 kPa), but only by SSM-SVR24 values (≤42 vs. >42 kPa).

Conclusions: Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement.

Lay summary: Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals.

Keywords: ACLD, advanced chronic liver disease; ALT, alanine aminotransferase; DAA; DAA, direct-acting antiviral; Direct-acting antiviral; HCC; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; INR, international normalised ratio; LSM, liver stiffness measurement; Liver stiffness; MELD, model for end-stage liver disease; SSM, spleen stiffness measurement; SVR, sustained virologic response; Spleen stiffness; TE, transient elastography; Transient elastography.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
HCC-free survival according to the new algorithm based on LSM and SSM values after viral eradication. Value of p by log-rank. HCC, hepatocellular carcinoma; LSM, liver stiffness measurement; SSM, spleen stiffness measurement.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Pawlotsky J.-M., Aghemo A., Berenguer M., Dalgard O., Dusheiko G., Marra F. EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73:1170–1218. - PubMed
    1. Carrat F., Fontaine H., Dorival C., Simony M., Diallo A., Hezode C. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. Lancet. 2019;393:1453–1464. - PubMed
    1. Ioannou G.N., Green P.K., Berry K. HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma. J Hepatol. 2018;68:25–32. - PMC - PubMed
    1. Kanwal F., Kramer J., Asch S.M., Chayanupatkul M., Cao Y., El-Serag H.B. Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents. Gastroenterology. 2017;153:996–1005.e1. - PubMed
    1. Ioannou G.N. HCC surveillance after SVR in patients with F3/F4 fibrosis. J Hepatol. 2021;74:458–465. - PubMed

LinkOut - more resources