Clinical Model for Predicting Hepatocellular Carcinomas in Patients with Post-Sustained Virologic Responses of Chronic Hepatitis C: A Case Control Study

Abstract

Background/AimsNo clinical model exists to predict the occurrence of hepatocellular carcinoma in sustained virologic response-achieving (HCC after SVR) patients with chronic hepatitis C (CHC).MethodsWe performed a case-control study using a clinical database to research the risk factors for HCC after SVR. A predictive model based on risk factors was established, and the area under the receiver operating characteristic curve (AUC) was calculated.ResultsIn the multivariate model, an initial diagnosis of compensated cirrhosis and post-SVR albumin reductions of 1 g/L were associated with 21.7-fold (95% CI, 4.2 to 112.3; p<0.001) and 1.3-fold (95% CI, 1.1 to 1.7; p=0.004) increases in the risk of HCC after SVR, respectively. A predictive model based on an initial diagnosis of compensated cirrhosis (yes, +1; no, 0) and post-SVR albumin ≤36.0 g/L (yes, +1; not, 0) predicted the occurrence of HCC after SVR with a cutoff value of >0, an AUC of 0.880, a sensitivity of 0.833, a specificity of 0.896, and a negative predictive value of 0.956.ConclusionsAn initial diagnosis of compensated cirrhosis combined with a post-SVR albumin value of ≤36.0 g/L predicts the occurrence of HCC after SVR in patients with CHC.

Unexpected high incidence of hepatocellular carcinoma in patients with hepatitis C in the era of DAAs: Too alarming?

“…In the IFN era, the incidence of HCC in SVR-achieving or even in antiviral-treated hepatitis C patients is very low [6]. Our previous study [7] reported that the overall rate of HCC after SVR was 1.2% (26/2,130) during a median post-SVR time of 17.5 months at The First Affiliated Hospital of Zhengzhou University and Beijing 302 Hospital, which are the largest tertiary general hospital (containing 11,000 clinical beds) and the largest liver disease hospital (containing 1200 clinical beds) in China, respectively. However, the unexpectedly high incidence of HCC in the DAA era is in sharp contrast to that in the former interferon era.…”

“…First, the indications of anti-HCV therapy have largely expanded during the era of DAAs [2,8]. As in prior reports [6,7], older age and the presence of cirrhosis at SVR or initiation of treatment were two important factors related to the development of HCC after SVR. We have sound reasons to believe that relatively older and more advanced cirrhotic patients are currently receiving and will receive DAA therapy in the future.…”