"Patients With HCV-Associated Cirrhosis Remain at Risk for Developing HCC After Achieving SVR"
Source: 2013 Annual Meeting of the American Association for the Study of Liver Diseases*
Date posted: 11/6/2013
Meta-analysis of previously reported cohort studies[1]
Summary of Key Conclusions:
* Annual risk for hepatocellular carcinoma (HCC) approximately 1% in patients with HCV-induced cirrhosis who have attained SVR
* Risk increased with advanced age, more severe liver disease, and diabetes
* A population aging with chronic HCV infection and more effective antiviral regimens likely to result in an increased HCC incidence
* Authors suggest screening all cirrhotic patients who attain SVR for HCC until more risk stratification tools become available
Summary of Study Design
* Meta-analysis of individual patient data from 10 cohort studies conducted in Europe and Canada
* Eligible studies included consecutive patients chronically infected with HCV with advanced fibrosis/cirrhosis who attained SVR on interferon-based regimens
* Studies with HIV or HBV coinfection excluded
* Individual patient data excluded if developed HCC prior to start of follow-up (24 weeks post–antiviral therapy cessation)
* Kaplan-Meier analysis used to estimate cumulative HCC rates
* Differences between subgroups compared using log-rank test
Main Findings:
* 51 of 1000 patients (5.1%) developed HCC over median follow-up of 5.7 years (IQR: 2.9-8.0)
* Sex: no effect on rate of HCC (P = .474)
* Rate of HCC higher among patients with cirrhosis vs those with advanced fibrosis (P = .064)
* Older age significantly associated with greater cumulative rate of HCC in cirrhotic patients (P = .006)
HCC diagnosed in 3 patients with bridging fibrosis
* All patients had low platelet counts (≤ 166 platelets/mm3)
2 laboratory markers associated with HCC occurrence:
* Platelet count < 150,000 cells/mm3 (vs ≥ 150,000 cells/mm3) (P = .045)
* AST/ALT ratio ≥ 0.90 (P = .017)
* Factors independently associated with increased risk of developing HCC post-SVR included advanced age, low platelet count, and presence of diabetes
Hector