Stratification of Hepatocellular Carcinoma Risk Following HCV Eradication or HBV Control

Abstract

Hepatocellular carcinoma (HCC) incidence has dramatically decreased in patients infected with HCV and HBV due to the widespread use of highly effective antiviral agents. Nevertheless, a substantial proportion of patients with advanced fibrosis or cirrhosis following HCV clearance of in case of HBV control whatever the stage of fibrosis remains at risk of liver cancer development. Cancer predictors in these virus-free patients include routine parameters estimating coexisting comorbidities, persisting liver inflammation or function impairment, and results of non-invasive tests which can be easily combined into HCC risk scoring systems. The latter enables stratification according to various liver cancer incidences and allocation of patients into low, intermediate or high HCC risk probability groups. All international guidelines endorse lifelong surveillance of these patients using semi-annual ultrasound, with known sensibility issues. Refining HCC prediction in this growing population ultimately will trigger personalized management using more effective surveillance tools such as contrast-enhanced imaging techniques or circulating biomarkers while taking into account cost-effectiveness parameters.

Early hepatocellular carcinoma detection using magnetic resonance imaging is cost-effective in high-risk patients with cirrhosis

“…More recently, new stratification models have been developed in the current era of HCV eradication or HBV control and include routine parameters estimating coexisting comorbidities, persistent liver inflammation or functional impairment. 8 As described above, the global annual HCC incidence in patients with controlled HBV infection or cured HCV in the case of advanced chronic liver disease is similar to those observed in patients with cirrhosis due to non-viral causes, whether alcohol- or NASH-related. 12 , 25 For instance, using the US Veterans Affairs database, 12 the annual HCC incidence rates were 1.56% for NAFLD cirrhosis (n = 7,068) and 1.44% for ALD cirrhosis (n = 16,175).…”

“…However, most of these risk scores were designed prior to the widespread use of antiviral therapies and are now outdated since they assigned heavy weighting to virological parameters. More recently, new stratification models have been developed in the current era of HCV eradication or HBV control and include routine parameters estimating coexisting comorbidities, persistent liver inflammation or functional impairment [8]. As described above, the global annual HCC incidence in patients with controlled HBV infection or cured HCV in the case of advanced chronic liver disease is similar to those observed in patients with cirrhosis due to nonviral causes, whether alcohol-or NASH-related [12,25].…”

“…The main driver of the cost-effectiveness ratio is indeed the incidence of HCC in the population considered for screening since it determines the total amount expended on MRI, the receipt of curative treatment, and the overall survival in at-risk patients. Although heterogeneous at the individual level, the changing epidemiology of chronic liver diseases has recently reshaped HCC risk prediction [8]. This is notably the case in HCV-or HBV-infected patients with cirrhosis, in whom the incidence of HCC has dramatically decreased following the widespread implementation of antiviral agents [9,10].…”

“…Although heterogeneous at the individual level, the changing epidemiology of chronic liver diseases has recently reshaped HCC risk prediction. 8 This is notably the case in HCV- or HBV-infected patients with cirrhosis, in whom the incidence of HCC has dramatically decreased following the widespread implementation of antiviral agents. 9 , 10 Large prospective cohorts of patients with cirrhosis from Europe and the US have reported global annual HCC incidences ranging from 1.5% to 2.5% following HCV eradication 11 or HBV control, 9 which are similar to those observed in patients with non-viral causes of cirrhosis, whether alcohol- or non-alcoholic fatty liver disease (NAFLD)-related.…”

Virus-Induced Risk of Hepatocellular Carcinoma: Recent Progress and Future Challenges

“…What are the clinical challenges and opportunities of patient stratification and the translation of the experimental concepts into practice? Addressing these important questions, Pierre Nahon provides an overview of the current practices and challenges of patient stratification according to HCC risk during HBV control and after HCV cure [ 17 ]. Finally, Shen Li’s reviews emphasize secondary prevention strategies of HCC development and its translational challenges [ 18 ].…”