A second study, by Dr
Jennifer Kramer of the Center for Innovations in Quality, Effectiveness and
Safety and colleagues looked at liver cancer risk factors among people who were
cured of hepatitis C, assessed at one year and two years after treatment.
This analysis included
98,612 US veterans with hepatitis C who achieved SVR with DAA treatment
between January 2014 and December
2018. Almost all were men, half were White, 39% were Black and the mean age was 61 years. Nearly a third had
cirrhosis at the time of treatment. Patients with and without cirrhosis were
demographically similar, but the former group had higher bilirubin and albumin
levels and higher rates of diabetes, hypertension and obesity.
A total of 2298 people
developed HCC. Annual incidence rates for people with cirrhosis were 1.6%
during the first year post-treatment and 1.9% during the second year, compared
with 0.21% and
0.27%, respectively, for those without cirrhosis.
The researchers found
that liver cancer risk factors differed based on cirrhosis status. Among people
with cirrhosis, HCC predictors at 12 months included male sex, White race, HCV
genotype 3, longer cirrhosis duration, higher bilirubin levels and the presence
of oesophageal varices. Changes in albumin levels and worsening fibrosis (as
indicated by FIB-4 score) also predicted HCC risk. However, race, HCV genotype and
bilirubin were no longer significant predictors at 24 months while changes in
haemoglobin level became a significant factor. Non-smokers had a lower HCC
Among people without cirrhosis, metabolic factors such as diabetes and
hypertension, as well as worsening fibrosis, were strongly associated with HCC
risk at both time points.
"In a cohort of patients with
virologically cured HCV infection, risk factors for HCC were different in
patients with and without cirrhosis," the researchers concluded. "In
patients with cirrhosis, they were mostly disease severity related, whereas
metabolic traits were important in patients without cirrhosis."
they added, could inform decisions about HCC surveillance in people cured of
hepatitis C. Because risk factors can change over time, they suggested that
repeated assessment at two years "is practical and can improve risk stratification" in patients
cured of HCV, regardless of their cirrhosis status.