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. 2022 Jun-Jul;46(6):101923.
doi: 10.1016/j.clinre.2022.101923. Epub 2022 Apr 9.

Prediction of hepatocellular carcinoma in Hepatitis C patients with advanced fibrosis after sustained virologic response

Jessica Azzi  1 , Céline Dorival  1 , Carole Cagnot  2 , Hélène Fontaine  3 , Clovis Lusivika-Nzinga  1 , Vincent Leroy  4 , Victor De Ledinghen  5 , Albert Tran  6 , Fabien Zoulim  7 , Laurent Alric  8 , Jérôme Gournay  9 , Jean-Pierre Bronowicki  10 , Thomas Decaens  11 , Ghassan Riachi  12 , Nabiel Mikhail  13 , Reham Soliman  14 , Gamal Shiha  15 , Stanislas Pol  16 , Fabrice Carrat  17 , Nathalie Ganne-Carrié  18 ; ANRS-AFEF Hepather Study group
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Free article

Prediction of hepatocellular carcinoma in Hepatitis C patients with advanced fibrosis after sustained virologic response

Jessica Azzi et al. Clin Res Hepatol Gastroenterol. 2022 Jun-Jul.
Free article

Abstract

Background & aims: Prediction of hepatocellular carcinoma (HCC) occurrence in patients with chronic hepatitis C (HCV) who achieved a sustained virological response (SVR) after direct acting antivirals (DAAs) remains challenging.

Methods: Among HCC-free HCV patients with advanced fibrosis enrolled in the ANRS CO22 HEPATHER cohort who achieved SVR 12 weeks after treatment with DAAs, HCC predictive models were developed using Cox multivariable regression. The derived score was externally validated in a large Egyptian cohort. Our main outcome was the HCC-free survival.

Results: During follow-up (median 3.05 years), 153 out of 3531 patients developed a HCC. Main variables associated with HCC occurrence were: male gender, HCV genotype 3, esophageal varices, albumin < 40 g/L, total bilirubin >11 µmol/L and hypercholesterolemia before DAA initiation, together with age > 58 years, FIB-4 index ≥3.25 evaluated at SVR. A score was established allowing the stratification of patients by high (score ≥ 12/22), intermediate (7 ≤ score <12) and low risk of HCC (score < 7/22) with 3-yrs HCC incidence of 18.96%, 5.50% and 1.65%, respectively. The integrated time-dependent area under the ROC curve (i-AUC) was 0.76 in our patients and 0.61 in the validation cohort.

Conclusion: The externally validated HEPATHER HCC score has good short-term predictive performance in HCV- patients who achieved SVR12 after DAAs allowing to identify high-risk patients in whom HCC screening may be cost-effective and low-risk patients in whom HCC screening may be superfluous in the first 3 years after SVR.

Keywords: HCC; Hepatitis C virus; Risk factors; Risk score.

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Conflict of interest statement

Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. J. Azzi, C. Dorival, C. Cagnot, C. Luzivika Nzinga, N. Mikhal, R. Soliman and G. Shiha have nothing to disclose. H. Fontaine reports personal fees and invitations for medical meeting from Gilead, Abbvie, BMS, MSD, Janssen, outside this work. V. Leroy reports grants, personal fees and non-financial support from Abbvie, grants, personal fees and non-financial support from BMS, grants, personal fees and non-financial support from Gilead, personal fees and non-financial support from MSD, personal fees from echosens, outside the submitted work. V. De Ledinghen has received consulting and/or lecturing fees from Gilead, AbbVie, Echosens, Intercept Pharma, SuperSonic Imagine, Indivior, Spimaco, Pfizer, Bristol Myers Squibb, Myr-Pharma. A. Tran reports personal fees from Abbvie, Gilead, MSD, BMS, JANSSEN outside the submitted work. F. Zoulim reports personal fees from Abbvie, Gilead, during the conduct of the study. L. Alric reports research grants or personal fees from Abbvie, Gilead, MSD, BMS, JANSSEN not related to the submitted work. J. Gournay reports personal fees from Gilead, MSD, Abbvie, during the conduct of the study; personal fees from Intercept, outside the submitted work. JP. Bronowicki reports personal fees from Abbvie, Gilead, MSD, BMS, JANSSEN outside the submitted work. T. Decaens reports consulting and/or lecturing and/or reserch fees from BMS, Astra Zeneca, Roche, Bayer, IPSEN, Abbvie, Gilead, MSD, SIRTEX, Guerbet, ArQule, GenoScience, outside the submitted work. G. Riachi reports personal fees and invitations for medical meeting from Gilead, Abbvie, MSD, outside this work. S. Pol has received consulting and lecturing fees from Bristol-Myers Squibb, Janssen, Gilead, Roche, MSD, MYR_Pharma, Shionogi, Biotest and Abbvie, and grants from Bristol-Myers Squibb, Gilead, Roche and MSD. F. Carrat reports grants from INSERM-ANRS, during the conduct of the study. N. Ganne-Carrié received personal fees and invitations for medical meetings from Abbvie, Bayer, Gilead, Ipsen, and Shionogi, outside the submitted work.

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