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

Dajti, Elton; Marasco, Giovanni; Ravaioli, Federico; Ferrarese, Alberto; Festi, Davide; Colecchia, Antonio

doi:10.1016/j.jhepr.2021.100289

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…(81) The authors found that SS significantly correlated with changes in HVPG following NSBB therapy (r = 0.784; P<0.0001) while LS measured by TE did not (r = 0.107, P = 0.655). (81) Importantly, a ≥10% decrease in SS was an excellent predictor of HVPG response to NSBBs (area under the receiver Wang et al (104) HBV, cACLD VCTE Rule out HRV: ≤46 kPa n = 341 Dajti et al (73) ACLD Low-risk VNT: ≤46 kPa Dajti et al (120) HCV-related ACLD VCTE High-risk HCC: >42 kPa n = 140…”

Section: Liver Stiffness Versus Spleen Stiffnessmentioning

confidence: 99%

The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis

Reiberger

2021

Hepatol Commun

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Patients with compensated advanced chronic liver disease who develop clinically significant portal hypertension (CSPH) are at high risk for hepatic decompensation and mortality if left untreated. Liver biopsy and hepatic venous pressure gradient (HVPG) measurements are the current gold standard procedures for determining fibrosis severity and diagnosing CSPH, respectively; however, both are invasive, limiting their use in clinical practice and larger trials of novel agents. As such, there is an unmet clinical need for reliable, validated, noninvasive measures to detect CSPH and to further assess portal hypertension (PH) severity. Alterations in the biomechanical properties of the liver or spleen in patients with cirrhosis can be quantified by tissue elastography, which examines the elastic behavior of tissue after a force has been applied. A variety of methods are available, including magnetic resonance elastography, shear‐wave elastography, and the most thoroughly investigated measure, vibration‐controlled transient elastography. Liver stiffness (LS) and spleen stiffness (SS) measurements offer valuable alternatives to detect and monitor CSPH. Both LS and SS correlate well with HVPG, with thresholds of LS >20‐25 kPa and SS >40‐45 kPa indicating a high likelihood of CSPH. Because SS is a direct and dynamic surrogate of portal pressure, it has the potential to monitor PH severity and assess PH improvement as a surrogate marker for clinical outcomes. Importantly, SS seems to be superior to LS for monitoring treatment response in clinical trials focusing on reducing PH.

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Section: Liver Stiffness Versus Spleen Stiffnessmentioning

confidence: 99%

The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis

Reiberger

2021

Hepatol Commun

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“…Clinically significant portal hypertension and related LREs may not be radically abolished, despite SVR or a decrease in LS [ 4 , 37 ]. Future LRE-predicting algorithms should employ a combination [ 38 ] of LS and spleen stiffness measurements, including delta values [ 39 , 40 ], to maximize the diagnostic performances, as well as by considering remnant portal hypertension after antiviral treatment completion. Sixth, concerns and controversies regarding differences in HCC risk after viral eradication by IFN- or DAA-based therapies have been clarified.…”

Section: Discussionmentioning

confidence: 99%

Combined Liver Stiffness and Α-fetoprotein Further beyond the Sustained Virologic Response Visit as Predictors of Long-Term Liver-Related Events in Patients with Chronic Hepatitis C

Chen

Lai

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Aims. Long-term risk stratification using combined liver stiffness (LS) and clinically relevant blood tests acquired at the baseline further beyond the sustained virologic response (SVR) visit for chronic hepatitis C (CHC) has not been thoroughly investigated. This study retrospectively investigated the prognostics of liver-related events (LREs) further beyond the SVR visit. Methods. Cox regression and random forest models identified the key factors, including longitudinal LS and noninvasive test results, that could predict LREs, including hepatocellular carcinoma, during prespecified follow-ups from 2010 to 2021. Kaplan–Meier survival analysis estimated the significance of between-group risk stratification. Results. Of the entire eligible cohort (n = 520) of CHC patients with SVR to antiviral therapy, 28 (5.4%) patients developed post-SVR LREs over a median follow-up period of 6.1 years (interquartile range = 3.5–8.7). The multivariate Cox regression analysis identified two significant predictors of LREs after the year 3 post-SVR (Y3PSVR) baseline (LRE, n = 15 of 28, 53.6%, median follow-up = 4.1 [1.6–6.4] years after Y3PSVR): LS at Y3PSVR (adjusted hazard ratio [aHR] = 3.980, 95% confidence interval [CI] = 2.085–7.597, P < 0.001 ), and α-fetoprotein (AFP) at Y3PSVR (aHR = 1.017, 95% CI = 1.001–1.034, P = 0.034 ). LS ≥1.45 m/s and AFP ≥3.00 ng/mL for Y3PSVR yielded positive likelihood ratios of 4.24 and 2.62, respectively. Kaplan–Meier analysis revealed that among the stratified subgroups, the subgroup with concurrent LS ≥1.45 m/s and AFP ≥3.00 ng/mL at Y3PSVR exhibited the highest risk of LREs after Y3PSVR (log-rank P < 0.001 ). Conclusion. We recommend the combined use of concurrent LS and AFP in future prediction models for LREs in CHC. Patients with concurrently high LS and AFP values further beyond the SVR visit may require a recall policy involving intense surveillance.

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“…These results were validated in a cohort of cACLD patients. Spleen stiffness does not decrease after viral eradication, as opposed to liver stiffness [ 29 ], and it seems to be able to predict the risk of HCC [ 30 ]. Thus, the association between spleen stiffness and HVPG after viral eradication should be investigated to assess the potential role of spleen stiffness in the surveillance of CSPH after SVR.…”

Section: Impact On Clinically Significant Portal Hypertensionmentioning

confidence: 99%

Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals

Lynch

Russo

2023

JCM

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Treatment of hepatitis C (HCV) has been revolutionized with the introduction of direct-acting antivirals (DAAs). Patients can be treated at more advanced stages of liver disease, with a growing number of cirrhotic patients achieving sustained virological response (SVR). Long-term outcomes for cured patients and the optimal follow-up care of patients after SVR are yet to be defined, because most studies on cirrhotic patients cured with DAAs have a short follow-up period. There are many open questions related to patient management after viral eradication with DAAs, such as which could be the most reliable non-invasive tool to predict liver-related complications, or to what extent viral eradication reduces the risk of liver disease progression in the long term. Growing evidence supports the personalization of follow-up care based on individual risk. The aim of this narrative review is to analyze the impact of viral eradication with DAAs on clinically significant portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as to summarize indications for optimal follow-up care of HCV patients treated with DAAs.

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

Cited by 17 publications

References 25 publications

The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis

The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis

Combined Liver Stiffness and Α-fetoprotein Further beyond the Sustained Virologic Response Visit as Predictors of Long-Term Liver-Related Events in Patients with Chronic Hepatitis C

Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals

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