Risk of HCC remains elevated after achieving SVR

SAN FRANCISCO — In the pre–direct-acting antiviral era, risk of hepatocellular carcinoma remained slightly elevated in those patients with hepatitis C virus who achieved SVR, according to a presentation at The Liver Meeting 2015. That risk was further elevated in those patients who were older, with cirrhosis, diabetes and previous genotype 3 disease.

“Available information does not allow for precise estimation of HCC risk, determinants or the temporal change of HCC risk after SVR,” Hashem El-Serag, MD, from the Houston VA Medical Center and Baylor College of Medicine, Houston, Texas, said in his presentation. “And the required clinical follow-up for patients who achieve SVR [is] unclear.”

In the retrospective cohort study of the national VA HCV Clinical Case Registry, El-Serag and colleagues looked at patients diagnosed with HCV between October 1999 and January 2010. They found 33,005 patients infected with HCV who received treatment, of whom 10,817 achieved SVR and 10,738 were not diagnosed with HCC prior to achieving SVR. El-Serag noted that the treatment at that time was pegylated interferon with or without ribavirin.

In the follow-up (30,562 person years, median duration 2.7 years), researchers found that 100 patients were diagnosed with HCC for an incidence rate of 0.327% per year. In those patients who did not achieve SVR, the incidence rate of HCC was 1.32% per year. This resulted in a hazard ratio of 0.358 for SVR vs. no SVR, El-Serag said.

Among those who achieved SVR, patients aged 65 years and older were more than four times as likely to develop HCC (HR = 4.69, 95% CI, 2.04-10.78). Those with cirrhosis (HR = 4.45, 95% CI, 2.53-7.82) and diabetes (HR = 2.07; 95% CI, 1.35-3.2) were also at higher risk. Lastly, patients with genotype 3 HCV were at nearly double the risk of developing HCC (HR = 1.91, 95% CI, 1.14-3.18).

“The risk of HCC after HCV cure, while considerably reduced, remains relatively high at 0.33% per year. Older age and/or presence of cirrhosis at the time of SVR are associated with a high HCC risk and warrant continued HCC surveillance and suggest to treat and cure early and young,” El-Serag said. – by Katrina Altersitz

Reference:

Richardson P, et al. Abstract 86. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: El-Serag reports financial relationships with Gilead Sciences and WAKO. Please see the abstract for a list of all authors’ disclosures.