Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience
- 42 Downloads
The aim of this study was to evaluate the relationship between the liver stiffness measurement and the risk of developing hepatocellular carcinoma (HCC) in HCV cirrhotic patients undergoing new direct-acting antivirals.
From April 2015 to April 2017, all consecutive HCV cirrhotic patients treated by direct-acting antivirals were enrolled. A liver stiffness measurement was computed at baseline, and an ultrasound evaluation was provided for all patients at baseline and every 6 months until 1 year after the stopping of the antiviral therapy. The diagnosis of HCC was performed according to international guidelines by imaging technique workup.
Two hundred and fifty-eight HCV patients with a diagnosis of cirrhosis were identified. The median liver stiffness was 25.5 kPa. Thirty-five patients developed HCC. Patients were divided into three groups, based on their liver stiffness: < 20 kPa (n = 72), between 20 and 30 kPa (n = 92) and > 30 kPa (n = 94). Compared to the < 20 kPa and 20–30 kPa groups, the > 30 kPa group showed a statistically significant increased risk of HCC (p = 0.019; HR 0.329; 95% CI 0.131–0.830). A ROC curve analysis to assess the overall predictive performance of liver stiffness measurement on the HCC risk was performed. The results allow us to identify a cutoff value of liver stiffness measurement equal to 27.8 kPa, which guarantees the highest sensitivity and specificity (respectively, 72% and 65%).
The data underline that the baseline liver stiffness measurement and ultrasound surveillance is a valuable tool for assessing the risk of HCC in cirrhotic patients undergoing the direct-acting antivirals treatment.
KeywordsTransient elastography Direct-acting antiviral HCC HCV cirrhosis Liver stiffness
Compliance with ethical standards
Conflict of interest
The authors declare that they have not any personal or financial conflicts of interest.
- 9.Feier D, Lupsor Platon M, Stefanescu H, et al. Transient elastography for the detection of hepatocellular carcinoma in viral C liver cirrhosis. Is there something else than increased liver stiffness? J Gastrointestin Liver Dis. 2013;22:283–289.Google Scholar
- 12.AISF Documento di indirizzo dell’Associazione Italiana per lo Studio del Fegato per lo studio razionale di antivirali diretti della seconda generazione nelle categorie di pazienti affetti da epatite C cronica ammesse alla rimborsabilità in Italia. Available at: http://www.webaisf.org/pubblicazioni/documento-aisf-hcv-2016.aspx.
- 20.Di Francia R, Rinaldi L, Troisi A, et al. Effect of anti-oxidant agents in patients with hepatocellular diseases. Eur Rev Med Pharmacol Sci. 2015;19:3993–3995.Google Scholar
- 24.Zampino R, Pisaturo MA, Cirillo G, et al. Hepatocellular carcinoma in chronic HBV-HCV co-infection is correlated to fibrosis and disease duration. Ann Hepatol. 2015;14:75–82.Google Scholar
- 29.Bachofner JA, Valli PV, Kröger A, et al. Direct antiviral agent treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers fibrosis-4 score and aspartate aminotransferase-platelet ratio index. Liver Int. 2017;37:369–376. https://doi.org/10.1111/liv.13256.CrossRefGoogle Scholar
- 30.Perrella A, Izzi A, Punzi R, et al. Late HCC onset after direct antiviral agents therapy in patients with sustained virological response: do we need to reconsider their efficacy according to long term follow-up? Scand J Gastroenteol. 2018;53:1025–1026. https://doi.org/10.1080/00365521.2018.1495260.CrossRefGoogle Scholar
- 31.Rinaldi L, Di Francia R, Coppola N, et al. Hepatocellular carcinoma in HCV cirrhosis after viral clearance with direct acting antiviral therapy: preliminary evidence and possible meanings. World Cancer Res J. 2016;3:e748.Google Scholar
- 33.Guarino M, Sessa A, Cossiga V, Special Interest Group on “Hepatocellular carcinoma and new anti-HCV therapies” of the Italian Association for the Study of the Liver, et al. Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: a few lights and many shadows. World J Gastroenterol. 2018;24:2582–2595. https://doi.org/10.3748/wjg.v24.i24.2582.CrossRefGoogle Scholar
- 36.Debes JD, van Tilborg M, Groothuismink ZMA, et al. Levels of cytokines in serum associate with development of hepatocellular carcinoma in patients with HCV infection treated with direct-acting antivirals. Gastroenterology. 2018;154:515–517. https://doi.org/10.1053/j.gastro.2017.10.035.CrossRefGoogle Scholar