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. 2024 Apr;22(4):778-788.e7.
doi: 10.1016/j.cgh.2023.11.020. Epub 2023 Dec 5.

Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis

Binu V John  1 , Yangyang Dang  2 , David E Kaplan  3 , Janice H Jou  4 , Tamar H Taddei  5 , Seth A Spector  6 , Paul Martin  7 , Dustin R Bastaich  2 , Hann-Hsiang Chao  8 , Bassam Dahman  2
Affiliations

Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis

Binu V John et al. Clin Gastroenterol Hepatol. 2024 Apr.

Abstract

Background & aims: Patients with cirrhosis secondary to chronic hepatitis C virus (HCV) are at risk for hepatocellular carcinoma (HCC) despite a sustained virological response (SVR). We examined whether post-SVR liver stiffness measurement (LSM) could be used to stratify HCC risk.

Methods: This was a retrospective cohort study of 1850 participants identified from the Veterans Health Administration, with HCV cirrhosis and SVR, followed up over 5099 person-years, from the time of post-SVR elastography until death, HCC, or the end of the study.

Results: The risk of HCC increased by 3% with every 1-kPa increase in LSM (adjusted hazard ratio [aHR], 1.03, 95% confidence interval [CI], 1.01-1.04; P < .001) and decreased with the number of years from SVR (aHR, 0.79; 95% CI, 0.70-0.90; P = .0003). The adjusted annual risk of HCC was 2.03% among participants with post-SVR LSM <10 kPa, 2.48% in LSM 10-14.9 kPa (aHR, 1.71; 95% CI, 1.01-2.88; P = .046), 3.22% for LSM 15-19.9 kPa (aHR, 1.59; 95% CI, 0.78-3.20; P = .20), 5.07% among LSM 20-24.9 kPa (aHR, 2.55; 95% CI, 1.30-5.01; P = .01), and 5.44% in LSM ≥25 kPa (aHR, 3.03; 95% CI, 1.74-5.26; P < .0001). The adjusted annual risk of HCC was < 0.4% in participants with LSM <5 kPa and without diabetes mellitus.

Conclusions: LSM predicts rates of HCC in patients with HCV cirrhosis after SVR at multiple cutoff levels and offers a single test to predict portal hypertension-related complications and HCC. Patients with LSM <5 kPa in the absence of diabetes mellitus had a low risk of HCC in which surveillance could be discontinued.

Keywords: Baveno VII; Cancer Surveillance; FIB-4; FibroScan; Liver Cancer; Liver Elastography.

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Conflict of interest statement

Conflicts of Interests: Dr. John reported no conflicts of interest related to this study. He received institutional research support from Gilead, Exact Sciences, and Glycotest Inc. He served on the advisory board for GSK, Astra Zeneca, and as a speaker for GSK. Dr. Kaplan received institutional research support from Gilead Sciences, Glycotest Inc., Astra Zeneca, Bayer, and Exact Sciences. None of the other authors has any personal or financial conflicts of interest concerning this publication.

Figures

Figure 1:
Figure 1:
Study flow chart
Figure 2:
Figure 2:
Cumulative incidence of HCC by LSM and FIB-4, among participants with HCV cirrhosis after SVR
Figure 3:
Figure 3:
CIF plot for HCC risk by combining LSM and FIB-4, among patients with HCV cirrhosis after SVR
See this image and copyright information in PMC

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