While cirrhosis is clearly a major
risk factor for liver cancer, some people without advanced fibrosis can still
develop HCC after successful hepatitis C treatment.
Dr Yuki Tahata of Osaka University Graduate School of Medicine in Japan
and colleagues aimed to develop a scoring system to predict the likelihood of HCC in people without advanced fibrosis,
which could help clinicians identify those who require HCC surveillance.
This analysis included 1682
people with hepatitis C at 26 Japanese hospitals who did not have advanced
liver fibrosis (FIB-4 index score less than 3.25). They started DAA treatment
between September 2014 and October 2020 and achieved SVR 24 weeks after the end
of treatment. People with hepatitis B or HIV, those with a history of
liver cancer prior to SVR and liver transplant recipients were excluded. About
60% were women and the median age was 66 years.
participants underwent HCC surveillance using abdominal ultrasound prior to DAA
treatment, at the end of treatment and every six months thereafter. A total of
28 people developed HCC during follow-up, Tahata reported. The cumulative HCC incidence
rates at one, three and five years after SVR were 0.6%, 1.8% and 2.5%,
respectively, with an annual rate of less than 1.0%.
multivariate analysis, factors that were significantly associated with HCC
incidence after being cured were older age (65 or over), elevated ALT liver
enzymes (30 U/l or higher) and elevated alpha-fetoprotein levels (5.0 ng/ml or
higher) at the time of SVR.
enabled the researchers to develop a scoring system, called 3A, to predict the occurrence
of HCC after SVR, allocating one point for each of these factors. The
cumulative HCC incidence rate at one, three and five years post-SVR was 2.9%, 6.0%
and 7.9%, respectively, for people with a score of 2 or 3. For those with a
score of 1, the corresponding rates were 0.5%, 2.1% and 2.9%. But no patients
with a score of 0 developed HCC.
developed a new scoring system using these three factors to enclose patients
who need HCC surveillance after SVR, and this score may be useful for
stratification of HCC risk in patients without advanced liver fibrosis,” the