Association of liver stiffness and steatosis with hepatocellular carcinoma development in patients with hepatitis C virus infection who received direct-acting anti-viral therapy and achieved sustained virological response.

Tada, Toshifumi; Nishimura, Takashi; Matono, Tomomitsu; Yoshida, Masahiro; Yuri, Minako; Fujiwara, Aoi; Yuri, Yukihisa; Takashima, Tomoyuki; Aizawa, Nobuhiro; Ikeda, Naoto; Enomoto, Hirayuki; Kumada, Takashi; Iijima, Hiroko

AIM The pathogenic process underlying the development of hepatocellular carcinoma (HCC) is not yet clear in patients with chronic hepatitis C virus (HCV) who receive direct-acting antiviral (DAA) therapy and achieve sustained virological response (SVR). This study investigated two risk factors for HCC in these patients, specifically hepatic fibrosis and steatosis. METHODS A total of 355 patients in whom HCV was eradicated by DAAs were evaluated. Fibrosis and steatosis were assessed using transient elastography (TE) and the controlled attenuation parameter (CAP). Inverse probability weighting (IPW) was applied to patient age, sex, albumin-bilirubin, α-fetoprotein, history of HCC, TE, or CAP. RESULTS The 12-, 24-, and 36-month cumulative incidence rates of HCC were 0.9%, 2.4%, and 4.1%, respectively. Univariate analysis with Cox proportional hazards model showed that while a high TE value (≥10 kPa) was significantly associated with HCC development (hazard ratio [HR], 7.861; 95% confidence interval [CI], 2.126-29.070; p=0.002), while CAP was not. Additionally, univariate analysis with Cox proportional hazards model adjusted by IPW showed that a high TE value was significantly associated with HCC development (HR, 3.980; 95% CI, 1.036-15.290; p=0.044), while CAP was not. The cumulative IPW-adjusted incidence of HCC rates at 12, 24, and 36 months were 0.0%, 0.5%, and 1.7%, respectively, in patients with a low TE value, and 2.5%, 5.1%, and 7.6%, respectively, in those with a high TE value. CONCLUSION A high TE value was a risk factor for HCC in HCV patients who received DAA therapy and achieved SVR. This article is protected by copyright. All rights reserved.