Dajti Elton, Marasco Giovanni, Ravaioli Federico, Colecchia Luigi, Ferrarese Alberto, Festi Davide, Colecchia Antonio
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
JHEP Rep. 2021 Apr 14;3(3):100289. doi: 10.1016/j.jhepr.2021.100289. eCollection 2021 Jun.
BACKGROUND & AIMS: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs.
This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development.
During a median follow-up of 41.5 (IQR 32-49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001-1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 ≤10 kPa were at the lowest risk of HCC. In patients with LSM-SVR24 >10 kPa, HCC incidence was not further influenced by LSM values (10-20 kPa >20 kPa), but only by SSM-SVR24 values (≤42 >42 kPa).
Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement.
Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals.
使用直接抗病毒药物（DAA）清除丙型肝炎病毒（HCV）可降低但不能消除肝细胞癌（HCC）的风险。因此，有必要制定持续病毒学应答（SVR）后HCC的监测策略。我们旨在评估脾脏硬度测量（SSM）在接受DAA治疗的晚期慢性肝病（ACLD）患者队列中预测HCC风险的作用。
这是一项对2015年至2017年期间在我们中心成功接受DAA治疗的140例HCV相关ACLD患者进行的回顾性队列研究。纳入治疗前和治疗后6个月（SVR24）有可用肝脏硬度（LSM）和SSM的患者。Cox回归模型研究了SSM与HCC发生之间的关联。
在中位随访41.5（IQR 32 - 49）个月期间，20例患者出现HCC。SVR24时的SSM在单变量和校正多变量分析中预测HCC发生（风险比：1.025；95% CI：1.001 - 1.050）；最佳截断值为42 kPa。LSM - SVR24≤10 kPa的患者HCC风险最低。在LSM - SVR24>10 kPa的患者中，HCC发病率不受LSM值（10 - 20 kPa>20 kPa）的进一步影响，而仅受SSM - SVR24值（≤42>42 kPa）的影响。
通过SSM评估的门静脉高压在DAA治疗后的肝脏致癌过程中起重要作用。我们提出了一种基于治疗后LSM和SSM值的新算法，用于在实现SVR后对HCC风险进行分层。
脾脏硬度可预测病毒清除后肝细胞癌的发生，尤其是在治疗后肝脏硬度值>10 kPa的患者中。基于肝脏和脾脏硬度的算法可对肝癌发生风险进行分层，并指导直接抗病毒药物治疗后的监测策略。
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