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Post-HCV therapy liver cancer risk models reduce excess screening

Liver disease researchers recently published internally validated models that estimated the risk for hepatocellular carcinoma following direct-acting antiviral therapy for hepatitis C based on the presence of cirrhosis and sustained virologic response outcome.

“These models, which are available as web-based tools, can help stratify patients according to HCC risk, and consequently, help determine an appropriate screening strategy based on a patient’s calculated risk,” George N. Ioannou, MD, from the University of Washington, and colleagues wrote. “A screening strategy targeting those who exceed a certain predetermined HCC risk may be more efficacious and cost-effective than the current ‘screen-all’ or ‘screen-none’ strategies which depend solely on cirrhosis status.”

Ioannou and colleagues collected data on 45,810 patients from the Veterans Health Administration who initiated DAA therapy between Jan. 1, 2009, and Dec. 31, 2015. Of those, 23% had cirrhosis and 74% achieved SVR. Most patients received DAA therapy alone (64%), while 22.5% received only interferon therapy and 13.5% received a combination.

During a mean follow-up period of 2.52 years, 2.8% of patients developed HCC. The incidence of HCC was highest among patients with cirrhosis who did not achieve SVR (5 per 100 patient-years), followed by the group with cirrhosis and SVR (2.2 per 100 patient-years), the group without cirrhosis or SVR (1.1 per 100 patient-years), and the group without cirrhosis who achieved SVR (0.3 per 100 patient-years).

After exploring several models with different risk factors, the researchers settled on a set based on findings using hypothetical patients:

• Patients with cirrhosis who do not achieve SVR have an extremely high predicted 3-year HCC risk of 25.9% and should consider screening with CT or MRI.
• Patients with cirrhosis who achieve SVR have a relatively low 3-year risk (1.6%) up to a high 3-year risk (11.1%) depending on the absence or presence of adverse predictors.
• Patients without cirrhosis who do not achieve SVR may have a sufficiently high risk for HCC (7%) to merit screening.

“Employing our models and limiting surveillance to patients who exceed a certain HCC risk threshold would be expected to reduce the ‘harms’ of unnecessary screening in patients who will not develop HCC (including costs and harms of unnecessary imaging studies, liver biopsies and other procedures) and increase the benefits by targeting patients who are more likely to develop HCC,” the researchers concluded. “Estimation of HCC risk enables individualized counseling of patients by their providers potentially leading to improved compliance with surveillance recommendations and engagement in care.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.