Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.
World J Gastroenterol. 2021 Oct 28;27(40):6737-6749. doi: 10.3748/wjg.v27.i40.6737.
Hepatitis C virus (HCV) chronic infection is associated with fibrosis progression, end-stage liver complications and HCC. Not surprisingly, HCV infection is a leading cause of liver-related morbidity and mortality worldwide. After sustained virological response (SVR), the risk of developing hepatocellular carcinoma is not completely eliminated in patients with established cirrhosis or with advanced fibrosis. Therefore, lifelong surveillance is currently recommended. This strategy is likely not universally cost-effective and harmless, considering that not all patients with advanced fibrosis have the same risk of developing HCC. Factors related to the severity of liver disease and its potential to improve after SVR, the molecular and epigenetic changes that occur during infection and other associated comorbidities might account for different risk levels and are likely essential for identifying patients who would benefit from screening programs after SVR. Efforts to develop predictive models and risk calculators, biomarkers and genetic panels and even deep learning models to estimate the individual risk of HCC have been made in the direct-acting antiviral agents era, when thousands of patients with advanced fibrosis and cirrhosis have reached SVR. These tools could help to identify patients with very low HCC risk in whom surveillance might not be justified. In this review, factors affecting the probability of HCC development after SVR, the benefits and risks of surveillance, suggested strategies to estimate individualized HCC risk and the current evidence to recommend lifelong surveillance are discussed.
丙型肝炎病毒 (HCV) 慢性感染与纤维化进展、终末期肝脏并发症和 HCC 有关。毫不奇怪，HCV 感染是全球导致肝脏相关发病率和死亡率的主要原因。在持续病毒学应答 (SVR) 后，对于已经存在肝硬化或晚期纤维化的患者，发展为肝细胞癌的风险并未完全消除。因此，目前建议进行终身监测。考虑到并非所有晚期纤维化患者发生 HCC 的风险相同，这种策略可能并非普遍具有成本效益和无害。与肝脏疾病严重程度及其在 SVR 后改善的潜力、感染过程中发生的分子和表观遗传变化以及其他相关合并症相关的因素可能导致不同的风险水平，并且可能对于确定 SVR 后受益于筛查计划的患者至关重要。在直接作用抗病毒药物时代，已经做出了许多努力来开发预测模型和风险计算器、生物标志物和基因面板，甚至深度学习模型来估计 HCC 的个体风险，当时已有数千名患有晚期纤维化和肝硬化的患者达到了 SVR。这些工具可以帮助确定 HCC 风险非常低的患者，对于这些患者，监测可能没有必要。在这篇综述中，讨论了 SVR 后 HCC 发展概率的影响因素、监测的益处和风险、估计个体 HCC 风险的建议策略以及推荐终身监测的现有证据。
