"HCC (liver cancer) risk persists 8 years after SVR"

[HectorSF]

For those with cirrhosis who achieve SVR. There is still a risk of developing HCC in the coming years although it is much lower than for those who don't achieve SRV and have cirrhosis.

"HCC (liver cancer) risk persists 8 years after HCV eradication"

Aleman S. Clin Infect Dis. 2013;doi:10.1093/cid/cit234.
May 9, 2013

The long-term risk for hepatocellular carcinoma among patients with hepatitis C remains up to 8 years after sustained virological response to antiviral therapy, researchers reported in Clinical Infectious Diseases.

“The number of patients with cancer was too low to draw any firm conclusion, but it was nevertheless somewhat surprising that the risk remained for such a prolonged time period,” Soo Aleman, MD, PhD, of the departments of gastroenterology and hepatology and infectious diseases at Karolinska Institutet in Stockholm, told Infectious Disease News.

“We need to know how long this risk persists and which subgroups of patients are at the highest risk after achieving sustained virological response (SVR). Future studies are needed to answer these questions.”

Aleman and colleagues conducted a prospective study that included patients who had HCV-related cirrhosis. Among the 351 patients, 110 reached SVR, 193 did not and 48 were untreated. The study was initiated in 2001 and the patients were followed for a mean of 5.3 years.

Six patients who achieved SVR developed hepatocellular carcinoma (HCC), for an incidence of 1 per 100 person-years. Two patients were diagnosed within a year after achieving SVR at 0.5 and 7.7 months, and the remaining four were diagnosed at 2.4, 7.4, 7.4 and 7.6 years.
All of the patients were tested for HCV RNA at HCC diagnosis, and all were negative.

Among patients who did not achieve SVR or who were untreated, the risk for HCC was higher. The risk for any liver-related complication, liver-related death or overall death was lower among patients who achieved SVR. These differences were similar after controlling for alcohol use, age, sex and diabetes.

“Patients who have liver cirrhosis prior to the eradication of HCV should continue to undergo surveillance with ultrasound regularly for early detection of hepatocellular carcinoma,” Aleman said.

Soo Aleman, MD, PhD, can be reached at Department of Gastroenterology and Hepatology, and Infectious Diseases, Karolinska University Hospital at Karolinska Institute, 171 76 Stockholm, Sweden; email: soo.***@****.

Disclosure: Aleman reports financial relationships with Gilead, Janssen, MSD and Roche.

H

[pooh55811]

Thanks so much for posting this Hector.

[ceanothus]

Thanks for posting this Hector. It matches up well with what my hepatologist told me upon achieving SVR, but its nice to see it confirmed in writing. He did say he'll want me to continue to get liver checkups (blood, US, and office visit) every six months for the rest of my life, but he assured me the visits would almost certainly all be very boring. Boring sounds great to me!

[willbb]

Thx.H

Also those with stage 3 damage( even if succesfully treated) may be well advised to confer with their physician  to do continous screening for HCC given possible underestimation of "level of liver damage" on biopsy

This is relatively current from CCO   based on patient profiles. In this  particular case  it is recommended he get frequent  HCC screening,albeit only Stage.3 given possibly Underestimating liver damage.

best.....

Will


Patient Case: Post Treatment Monitoring of Patients

The patient is a 56-year-old white male with genotype 1a HCV infection. A previous liver biopsy in 2009 revealed stage 3 bridging fibrosis. Laboratory findings are as follows: AST is 56 U/L, ALT is 47 U/L, total bilirubin is 0.8 mg/dL, albumin is 3.9 g/dL, prothrombin time 7.8 seconds, white blood cell count of 3.4 x 103 cells/μL, hemoglobin is 11.6 g/dL, and platelet count is 112,000 cells/μL. He is treated with telaprevir-based therapy for 12 weeks followed by peginterferon/ribavirin to Week 24, at which point he declined further therapy. HCV RNA is undetectable at treatment cessation and remains undetectable 24 weeks later.

How will the patient need to be followed in the coming years?

Analysis by Donald M. Jensen, MD:
HCC surveillance should be performed every 6 months for the remainder of this patient’s life. It is likely that this patient has cirrhosis based on his AST:ALT ratio and the presence of thrombocytopenia. The 2009 biopsy probably underestimated his degree of fibrosis, which is not uncommon. According to AASLD guidelines,[2] he should have received 48 total weeks of treatment, but he did respond successfully to 24 weeks. Patients with cirrhosis require continued surveillance for HCC since the risk persists, albeit reduced.[19] The risk of hemorrhage from esophageal varices, however, is nonexistent following SVR, and endoscopic surveillance for these is not necessary.[37]


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[rivll]

Thanks for that Hector. There is a tendency to just want to move on and not look back, but your post has reminded me to be prudent.

[Dee1956]

Hector, thank you for this post.  It is very helpful to me and I know others are being helped even if they don't say so.
Since I got to SVR I have been negligent in going back to the doctor.  I could say it is because of various "life events" however I just did not make the time to go back.  It has now been 10 months since I had the ultrasound or blood work.
I have made an appt to go in to be checked.  I am making this a priority.
Thank you so much for sharing, you are invaluable here.
My best to you (((HECTOR)))
Dee

[Lindaz]

A great post outlining the fact that regular surveillance is needed.   I have no cirrhosis but was told by my hepatologist that it was wise to have 3 - 5 yearly ultrasounds to check for any nodules that may appear on my liver even though I have SVR 2009.  

All the best Hector x