Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience

Rinaldi, Luca; Guarino, Maria; Perrella, Alessandro; Pafundi, Pia Clara; Valente, Giovanna; Fontanella, Luca; Nevola, Riccardo; Guerrera, Barbara; Iuliano, Natalina; Imparato, Michele; Trabucco, Alessio; Sasso, Ferdinando Carlo; Morisco, Filomena; Ascione, Antonio; Piai, G.; Adinolfi, Luigi Elio

doi:10.1007/s10620-019-05604-8

Cited by 40 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Basal liver stiffness could be considered as a potential predictive factor for a HCC appearance in this setting. To test this hypothesis, we conducted a prospective study [ 101 ] on 258 HCV cirrhotic patients treated with DAAs, measuring basal liver stiffness (LS) by Fibroscan ® . Patients were divided into three groups, based on their liver stiffness: <20 kPa ( n = 72), between 20 and 30 kPa ( n = 92) and >30 kPa ( n = 94).…”

Section: Predictive Factors Of Hcc Appearance or Recurrencementioning

confidence: 99%

Risk of Hepatocellular Carcinoma after HCV Clearance by Direct-Acting Antivirals Treatment Predictive Factors and Role of Epigenetics

Rinaldi

Nevola

Franci

et al. 2020

Cancers

Self Cite

View full text Add to dashboard Cite

Direct-acting antivirals (DAAs) induce a rapid virologic response (SVR) in up to 99% of chronic hepatitis C patients. The role of SVR by DAAs on the incidence or recurrence of hepatocellular carcinoma (HCC) is still a matter of debate, although it is known that SVR does not eliminate the risk of HCC. In this review, we made an updated analysis of the literature data on the impact of SVR by DAAs on the risk of HCC as well as an assessment of risk factors and the role of epigenetics. Data showed that SVR has no impact on the occurrence of HCC in the short–medium term but reduces the risk of HCC in the medium–long term. A direct role of DAAs in the development of HCC has not been demonstrated, while the hypothesis of a reduction in immune surveillance in response to the rapid clearance of HCV and changes in the cytokine pattern influencing early carcinogenesis remains to be further elucidated. HCV induces epigenetic alterations such as modifications of the histone tail and DNA methylation, which are risk factors for HCC, and such changes are maintained after HCV clearance. Future epigenetic studies could lead to identify useful biomarkers and therapeutic targets. Cirrhosis has been identified as a risk factor for HCC, particularly if associated with high liver stiffness and α-fetoprotein values, diabetes and the male sex. Currently, considering the high number and health cost to follow subjects’ post-HCV clearance by DAAs, it is mandatory to identify those at high risk of HCC to optimize management.

show abstract

Section: Predictive Factors Of Hcc Appearance or Recurrencementioning

confidence: 99%

Risk of Hepatocellular Carcinoma after HCV Clearance by Direct-Acting Antivirals Treatment Predictive Factors and Role of Epigenetics

Rinaldi

Nevola

Franci

et al. 2020

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1][2][3] It has been suggested that liver stiffness, measured either before or after anti-viral treatment, is associated with the development of hepatocellular carcinoma (HCC), decompensated liver disease and death. [4][5][6][7][8][9][10][11] Liver stiffness can decrease up to 3-5 kPa within months after initiating anti-viral therapy due to the resolution of hepatic inflammation from viral suppression and also over years after viral eradication due to a regression of fibrosis. 12 The implications of liver stiffness values are therefore likely to be different for those measured before vs after anti-viral treatment.…”

Section: Introductionmentioning

confidence: 99%

Fibroscan liver stiffness after anti‐viral treatment for hepatitis C is independently associated with adverse outcomes

Vutien

Kim

Moon

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundFibroscan‐derived liver stiffness decreases after anti‐viral treatment for hepatitis C virus (HCV) infection, which may affect the associations and interpretation of liver stiffness.AimsTo assess whether liver stiffness pre‐ or post‐anti‐viral therapy is associated with the development of decompensated cirrhosis, hepatocellular carcinoma (HCC) or death.MethodsIn this retrospective cohort study, we identified US veterans who initiated HCV treatment and had at least one liver stiffness before (n = 492) or after (n = 877) HCV therapy. We used Cox proportional hazards regression (adjusting for age, race/ethnicity, history of cirrhosis, body mass index, diabetes, FIB‐4 score, Charlson comorbidity index, alcohol use disorder, Model for end‐stage liver disease score and sustained virological response status) to determine the associations between pre‐ or post‐treatment liver stiffness values and the development of decompensated cirrhosis, HCC, death or liver transplant.ResultsIn the post‐treatment liver stiffness cohort, during a mean follow‐up of 27.3 months, 21 (2.4%) developed decompensated cirrhosis, 26 (3.0%) developed HCC and 57 (6.5%) died or underwent liver transplant. Compared to patients with post‐treatment liver stiffness ≤12.5 kPa, those with post‐treatment liver stiffness >20 kPa, had higher rates of developing decompensated cirrhosis (adjusted HR 3.85, 95% CI 1.29‐11.50) and the composite outcome of death, liver transplant, decompensated cirrhosis or HCC (adjusted HR 1.95, 95% CI: 1.07‐3.56). There were no significant associations between pre‐treatment liver stiffness and any outcomes on multivariable analysis.ConclusionsPost‐treatment liver stiffness >20 kPa, but not pre‐treatment liver stiffness, was independently associated with the development of decompensated cirrhosis and the composite outcome in multivariable analyses. Measuring liver stiffness should be considered after anti‐viral treatment because it predicts adverse outcomes even beyond routinely available clinical predictors.

show abstract

“…2 Other elastography methods (shear wave elastography (acoustic radiation force impulse), magnetic resonance elastography) have also shown promise for the prediction of liver failure after LR, but are not used routinely. 51,52 The measurement of indocyanine green (ICG) clearance is widely used in Asia. It is a dynamic method for studying liver functional reserve that consists of evaluating the hepatic clearance of indocyanine green 15 minutes after its intravenous administration (ICG-R15); normal values of ICG-R15 are around 10%, 53 but ICG clearance is usually delayed in cases of liver disease.…”

Section: Improvements In Patient Selection Evaluation Of Liver Functionmentioning

confidence: 99%

Section: Improvements In Patient Selectionmentioning

confidence: 99%

New frontiers in liver resection for hepatocellular carcinoma

et al. 2020

View full text Add to dashboard Cite

Liver resection is one of the main curative options for early hepatocellular carcinoma (HCC) in patients with cirrhosis and is the treatment of choice in non-cirrhotic patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. In the last decades, improved surgical techniques and perioperative management, as well as better patient selection, have enabled the indications for liver resection to be expanded. In this review, we aim to describe the main indications for liver resection in the management of HCC, its role compared to percutaneous ablation and liver transplantation in the therapeutic algorithm, as well as the recent advances in liver surgery that could be used to improve the prognosis of patients with HCC.

show abstract

Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience

Cited by 40 publications

References 32 publications

Risk of Hepatocellular Carcinoma after HCV Clearance by Direct-Acting Antivirals Treatment Predictive Factors and Role of Epigenetics

Risk of Hepatocellular Carcinoma after HCV Clearance by Direct-Acting Antivirals Treatment Predictive Factors and Role of Epigenetics

Fibroscan liver stiffness after anti‐viral treatment for hepatitis C is independently associated with adverse outcomes

New frontiers in liver resection for hepatocellular carcinoma

Contact Info

Product

Resources

About