The impact of HCV eradication by direct‐acting antivirals on the transition of precancerous hepatic nodules to HCC: A prospective observational study

Abstract

Background & Aims It remains controversial whether the eradication of hepatitis C virus (HCV) by interferon (IFN)‐free anti‐HCV therapy using direct‐acting antivirals (DAAs) suppresses or promotes hepatocellular carcinoma (HCC) development. We investigated the influence of HCV eradication by DAA therapy on HCC development, by observing changes of non‐hypervascular hypointense nodules (NHHNs) by gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid‐enhanced magnetic resonance imaging (EOB‐MRI). Methods A total of 401 patients treated with DAA therapy who did not have a history of HCC were enrolled in this prospective cohort study. All patients underwent EOB‐MRI prior to the start of DAA therapy and were followed up periodically after therapy. The progression of NHHNs detected at baseline to typical HCC, as indicated by hypervascularization and the incidence of newly emergent NHHNs, was analyzed. Results In comparison of patients who achieved sustained virologic response (SVR) with propensity score‐matched patients with persistent HCV infection, there was no difference in the incidence of hypervascularization of NHHNs to typical HCC among patients who had NHHNs at baseline. Among patients who did not have NHHNs at baseline, the incidence of the new emergence of NHHNs did not differ between study patients and propensity score–matched patients with persistent HCV infection. Conclusions During a 2‐year observation period after SVR, the eradication of HCV by IFN‐free DAA therapy did not suppress or enhance HCC development. (UMIN000017020).

The emergence of non‐hypervascular hypointense nodules on Gd‐EOB‐DTPA‐enhanced MRI in patients with chronic hepatitis C

“…Although NHHNs emerged even after SVR in our previous study, 14 it will not emerge in patients whose liver fibrosis was mild before SVR. Given the dramatic increase in the number of HCV patients who achieved SVR in the era of interferon-free DAA therapy, this finding can be used for the stratification of the intensity of HCC surveillance after SVR.…”

“…Our previous study reported that 43.5% of NHHNs became hypervascularised during 12 months of follow‐up . In addition, the eradication of HCV with DAA‐based anti‐HCV therapy did not suppress this hypervascularisation if it existed before HCV eradication . Therefore, it is clinically important to identify patients with NHHNs in the liver, for whom intensive surveillance for HCC should be provided for early HCC detection.…”

“…In our previous studies, direct emergence of hypervascular HCC did not occur after sustained virological response (SVR), that is, HCV eradication, in patients with no history of HCC 21. However, some patients with baseline NHHNs showed progression to hypervascular HCC after SVR,14 suggesting that typical HCC does not develop after SVR without a NHHN stage in patients with no history of HCC, but HCC can develop after SVR in patients…”

Risk assessment of hepatocellular carcinoma development by magnetic resonance elastography in chronic hepatitis C patients who achieved sustained virological responses by direct‐acting antivirals

“…LR3/4 nodules are well known as a high‐risk factor of HCC development, and there are suggestions that patients with these nodules should be excluded from analysis. Therefore, subgroup analysis was performed except for patients with LR3/4 nodules.…”

“…In WFA + -M2BP and FIB-4, it was impossible to distinguish patients without HCC risk like liver stiffness (data not shown). This was one of the advantages of using liver stiffness for stratification of HCC risk.LR3/4 nodules are well known as a high-risk factor of HCC development,29,30 and there are suggestions that patients with these nodules should be excluded from analysis. Therefore, subgroup analysis was performed except for patients with LR3/4 nodules.…”