HCC risk stratification after cure of hepatitis C in patients with compensated advanced chronic liver disease

作者：Georg Semmler, Elias Laurin Meyer, K Kozbial, Philipp Schwabl, Stefanie Hametner‐Schreil, Alberto Zanetto, David Bauer, David Chromy, Benedikt Simbrunner, Bernhard Scheiner, Albert Friedrich Stättermayer, Matthias Pinter, R Schöfl, Francesco Paolo Russo, Helena Greenfield, Michael Schwarz, Caroline Schwarz, Michael Gschwantler, Sonia Alonso López, María Luisa Manzano, Adriana Ahumada, Rafael Bañares, Mònica Pons, Sergio Rodríguez‐Tajes, Joan Genescà, Sabela Lens, Michael Trauner, Péter Ferenci, Thomas Reiberger, Mattias Mandorfer · 发表于：Journal of Hepatology · 年份：2021 · DOI：10.1016/j.jhep.2021.11.025 · 被引用次数：135 · 研究领域：Hepatitis C virus research、Liver Disease Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in patients with advanced chronic liver disease (ACLD) caused by chronic hepatitis C who have achieved sustained virologic response (SVR). We developed risk stratification algorithms for de novo HCC development after SVR and validated them in an independent cohort. METHODS: We evaluated the occurrence of de novo HCC in a derivation cohort of 527 patients with pre-treatment ACLD and SVR to interferon-free therapy, in whom alpha-fetoprotein (AFP) and non-invasive surrogates of portal hypertension including liver stiffness measurement (LSM) were assessed pre-/post-treatment. We validated our results in 1,500 patients with compensated ACLD (cACLD) from other European centers. RESULTS: During a median follow-up (FU) of 41 months, 22/475 patients with cACLD (4.6%, 1.45/100 patient-years) vs. 12/52 decompensated patients (23.1%, 7.00/100 patient-years, p <0.001) developed de novo HCC. Since decompensated patients were at substantial HCC risk, we focused on cACLD for all further analyses. In cACLD, post-treatment-values showed a higher discriminative ability for patients with/without de novo HCC development during FU than pre-treatment values or absolute/relative changes. Models based on post-treatment AFP, alcohol consumption (optional), age, LSM, and albumin, accurately predicted de novo HCC development (bootstrapped Harrel's C with/without considering alcohol: 0.893/0.836). Importantly, t...