Up-to-date HCC screening after HCV cure improves survival in patients with cirrhosis
Click Here to Manage Email Alerts
Key takeaways:
- Staying up-to-date on screening at least 50% of the time in the 4 years before a diagnosis of HCC correlated with improved survival.
- It also increased likelihood of early-stage diagnosis and curative treatment.
Remaining current on screening for hepatocellular carcinoma correlated with a “survival benefit” in older adults with hepatitis C virus-related cirrhosis who achieved viral cure but later developed HCC, according to researchers.
“Multiple observational studies have demonstrated associations of HCC screening, consisting of semiannual imaging and alpha-fetoprotein measurement, with improved detection of early-stage HCC, receipt of curative treatment and overall survival,” Catherine Mezzacappa, MD, of the division of digestive diseases at Yale School of Medicine, and colleagues wrote in JAMA Network Open. “Individuals with HCV-associated cirrhosis who have achieved viral cure may be particularly susceptible to lapses in HCC screening due to treatment-induced stabilization of their liver disease. However, data on clinical HCC screening practices and outcomes in these patients are sparse.”
In a retrospective cohort study, researchers included 16,902 patients with HCV-related cirrhosis (median age, 64 years; 97.2% men) in the VA health care system who achieved HCV cure with direct-acting antivirals between 2014 and 2022. Of these, 1,622 patients developed HCC. The primary outcome was overall survival following diagnosis of HCC.
According to results, the mean percentage of time participants were up to date with HCC screening after HCV cure decreased from 53.9% to 40.5% from the first to fourth year of follow-up and subsequently increased to 64.2% among those who were still eligible for screening at 8 years. Results also demonstrated a gradual drop in annual cumulative incidence of HCC from 1 year through 8 years (2.4% vs. 1%).
In addition, patients with HCC who were up to date with screening at least 50% of the time in the 4 years before their diagnosis had improved overall survival, researchers reported.
According to multivariable analysis, each 10% increase in eligible follow-up spent up to date with HCC screening during this time also corresponded with a 3.2% decrease in the hazard of death (HR = 0.97; 95% CI, 0.95-0.99), as well as a hazard reduction of 8% for those diagnosed with HCC between 3 and 4 years after HCV cure and 13% for those diagnosed between 4 and 5 years. Researchers did not observe a correlation for those diagnosed with HCC more than 5 years after HCV cure.
Moreover, up-to-date screening correlated with a 10.1% (95% CI, 6.3-14) and 6.8% (95% CI, 2.8-11) increased likelihood of early-stage HCC diagnosis and curative treatment, respectively.
“In this cohort study of older adults with cirrhosis and cured HCV, HCC screening was associated with a survival benefit,” Mezzacappa and colleagues wrote. “As the population most impacted by HCV ages, the role of HCC screening after HCV cure requires ongoing evaluation to balance its potential harms and benefits. Our findings suggest that individuals with cirrhosis should be maintained in HCC screening after HCV cure.”
Collapse
Read more about
Click Here to Manage Email Alerts