Director of Hepatology, Veterans Affairs Puget Sound Healthcare System; Professor of Medicine, University of Washington, Seattle, WA.
J Hepatol. 2021 Feb;74(2):458-465. doi: 10.1016/j.jhep.2020.10.016. Epub 2020 Dec 7.
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.
抗病毒治疗清除 HCV 可降低但不能消除 HCC 风险。获得持续病毒学应答 (SVR) 后，已发生肝硬化的患者需要“无限期”进行 HCC 监测，因为即使在 SVR 多年后，他们的 HCC 风险似乎仍然很高。没有已确诊或已知肝硬化的患者，如果 HCC 风险足够高，在获得 SVR 后可能仍需要进行监测。在所有获得 SVR 的患者中，关键问题是如何可靠地估计 HCC 风险以及 HCC 风险随时间的变化，以确定患者是否可能受益于 HCC 监测。HCC 风险是决定是否以及如何筛查 HCC 的最重要因素之一。估计 HCC 风险的有前途的策略包括简化评分系统（如纤维化-4）、肝脏弹性成像和多变量 HCC 风险计算器。这些工具可能使未来能够进行风险分层和个体化、基于风险的监测策略（“精准 HCC 筛查”）。
