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HCC surveillance after SVR in patients with F3/F4 fibrosis
1Director of Hepatology, Veterans Affairs Puget Sound Healthcare System; Professor of Medicine, University of Washington, Seattle, WA.
Insights
Hepatitis C virus (HCV) treatment lowers liver cancer (HCC) risk but doesn't eliminate it. Patients with cirrhosis need lifelong HCC screening post-treatment, while others may need it based on individual risk assessment.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Hepatocellular carcinoma (HCC) remains a risk even after successful Hepatitis C virus (HCV) eradication with antiviral therapy.
- Patients with pre-existing cirrhosis have a persistently high HCC risk post-sustained virologic response (SVR), necessitating indefinite surveillance.
- HCC risk stratification is crucial for determining surveillance needs in all SVR patients, including those without prior cirrhosis.
Purpose of the Study:
- To evaluate the ongoing risk of hepatocellular carcinoma (HCC) after Hepatitis C virus (HCV) eradication.
- To identify optimal methods for estimating HCC risk and its temporal changes in patients achieving sustained virologic response (SVR).
- To inform the development of individualized, risk-based HCC surveillance strategies.
Main Methods:
- Review of existing literature on HCC risk post-HCV SVR.
- Analysis of factors influencing HCC development in treated HCV patients.
- Evaluation of emerging tools for HCC risk assessment, including fibrosis scoring, liver elastography, and risk calculators.
Main Results:
- HCV eradication significantly reduces, but does not abolish, the risk of developing HCC.
- Established cirrhosis is a key determinant of long-term high HCC risk, mandating lifelong surveillance post-SVR.
- Non-cirrhotic patients may also require HCC surveillance based on specific risk profiles.
Conclusions:
- Lifelong HCC surveillance is recommended for patients with cirrhosis who achieve SVR.
- Accurate HCC risk estimation is essential for guiding surveillance decisions in all SVR patients.
- Tools like FIB-4, elastography, and risk calculators show promise for personalized HCC screening ('precision HCC screening').
Abstract:
HCV eradication by antiviral treatment reduces but does not eliminate HCC risk. Patients with established cirrhosis require HCC surveillance "indefinitely" after sustained virologic response (SVR) because they appear to have a high risk of HCC even many years after SVR. Patients without established or known cirrhosis may still require surveillance after SVR if they have a sufficiently high HCC risk. In all patients who achieve SVR, the key question is how we can reliably estimate HCC risk, and the change in HCC risk over time, to determine whether the patient might benefit from HCC surveillance. HCC risk is one of the most important factors that should inform decisions of whether and how to screen for HCC. Promising strategies for estimating HCC risk include simplified scoring systems (such as fibrosis-4), liver elastography and multivariable HCC risk calculators. Such tools may enable risk stratification and individualised, risk-based surveillance strategies ("precision HCC screening") in the future.
