Advantage of liver stiffness measurement before and after direct‐acting antiviral therapy to predict hepatocellular carcinoma and exacerbation of esophageal varices in chronic hepatitis C

Abstract

Aim: The risk of development of hepatocellular carcinoma (HCC) persisted in patients with advanced fibrosis, even after achieving sustained virologic response (SVR). This study aimed to show the advantage of liver stiffness measurement (LSM) at baseline and after SVR to predict HCC occurrence and esophageal varices (EV) exacerbation.Methods: These risks were evaluated in 398 chronic hepatitis C patients without a history of HCC who achieved SVR after directacting antiviral agent and evaluated LSM at least twice during follow up. We defined liver cirrhosis and chronic hepatitis as LSM of ≥12 kPa and <12 kPa, respectively.Results: LSM was significantly correlated with serum fibrosis markers, such as Fib-4 index and Wisteria floribunda agglutinin-positive Mac-2 binding protein, at baseline and SVR at 24 weeks after treatment (SVR24). Five patients received preventive treatment of EV, but no EV bleeding occurred after SVR, and their LSM at baseline and SVR24 was significantly higher than that of other cirrhosis patients. The annual rate of HCC during the first 4 years was 1.5%. LSM in HCC patients tended to decrease after direct-acting antiviral agent therapies, but significantly higher than that of cirrhosis patients without HCC before and after treatment. Multivariate analysis identified LSM and alpha-fetoprotein at baseline and LSM at SVR24 as significant independent predictors of HCC. Conclusions:Evaluating LSM not only at baseline, but also SVR24, was found to be useful for the detection of advanced fibrosis patients at high risk of HCC occurrence and EV exacerbation. We recommend focused surveillance of HCC and EV for these patients.

Impact of viral eradication by direct‐acting antivirals on the risk of hepatocellular carcinoma development, prognosis, and portal hypertension in hepatitis C virus‐related compensated cirrhosis patients

“…Ogasawara et al . reported that liver stiffness at 24 weeks after EOT is a predictor for esophageal varices exacerbation after achieving SVR in patients with HCV‐related cirrhosis 36 . Measurement of liver stiffness before or after DAA therapy also seems to be advisable to predict the aggravation of EGV.…”

Oxidative Stress Management in Chronic Liver Diseases and Hepatocellular Carcinoma

“…From a report on the histological analysis of the resected liver, in patients who underwent liver resection due to HCC after an SVR, the liver stiffness measured by TE improved to the normal range, although histological fibrosis was evident as F4-cirrhosis [61]. A longitudinal analysis from Japan on liver stiffness before and after DAA showed that liver stiffness measurements decreased after an SVR24, while patients who developed HCC maintained higher liver stiffness than others [62]. In patients with higher liver stiffness, fibrosis-related activated hepatic stellate cells may be present; these cells produce cytokines, such as transforming growth factor (TGF)-β, which plays a prometastatic role in HCC by inducing epithelial-mesenchymal transition (EMT) [63].…”

Predicting Hepatocellular Carcinoma Risk in Patients with Chronic HCV Infection and a Sustained Virological Response to Direct-Acting Antivirals

“…Baseline LSM obtained by Acoustic Radiation Force Impulse (ARFI) or TE, was associated with an increased risk of post-treatment HCC ( Table 5 ) in three studies analysing SVR patients. 53 , 56 , 57 Tachi et al identified the 1.73 m/s threshold as the optimal cut-off to stratify CHC patients according to their de-novo HCC risk 56 ( Table 5 ). In the other two studies, baseline LSM ≥20 kPa and ≥17.5 kPa were associated with HCC occurrence in 398 and 773 CHC patients from Japan and Denmark, respectively.…”