Profiling the risk of hepatocellular carcinoma after long-term HCV eradication in patients with liver cirrhosis in the PITER cohort

Background and aims: Severe liver disease markers assessed before HCV eradication are acknowledged to usually improve after the SVR. We prospectively evaluated, in the PITER cohort, the long-term HCC risk profile based on predictors monitored after HCV eradication by direct-acting antivirals in patients with cirrhosis.Methods: HCC occurrence was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the post-treatment variables associated with de-novo HCC; their predictive power was presented in a nomo-gram.Results: After the end of therapy (median follow-up:28.47 months), among 2064 SVR patients, 119 (5.8%) developed de-novo HCC. The HCC incidence was 1.90%, 4.21%, 6.47% at 12-, 24-and 36-months from end-of-therapy, respectively (incidence rate 2.45/100 person-years). Age, genotype 3, diabetes, platelets (PLT) & LE;120,0 0 0/& mu;l and albumin & LE;3.5g/dl levels were identified as pre-treatment HCC indepen-dent predictors. Adjusting for age, the post-treatment PLT & LE;120,0 0 0/& mu;l (AdjHR 1.92; 95%CI:1.06-3.45) and albumin & LE;3.5g/dl (AdjHR 4.38; 95%CI 2.48-7.75) values were independently associated with HCC occur-rence. Two different risk profiles were identified by combining long-term post-therapy evaluation of PLT & LE; vs. > 120,0 0 0/& mu;l and albumin & LE; vs. > 3.5g/dl showing a significant different HCC incidence rate of 1.35 vs. 3.77/100 p-y, respectively. Conclusions: The nomogram score based on age, PLT and albumin levels after SVR showed an accurate prediction capability and may support the customizing management for early HCC detection.& COPY; 2023 The Author(s). Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

This study evaluated the long-term risk of hepatocellular carcinoma (HCC) in patients with cirrhosis after hepatitis C virus (HCV) eradication. Age, genotype 3, diabetes, platelets and albumin levels were identified as predictors of HCC risk. Furthermore, post-treatment platelet and albumin levels were found to independently predict HCC occurrence.