Liver Unit, Division of Gastroenterology & Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Liver Unit, Division of Gastroenterology & Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
Gastroenterol Hepatol. 2023 Dec;46(10):754-763. doi: 10.1016/j.gastrohep.2023.01.008. Epub 2023 Jan 27.
BACKGROUND & AIMS: Life-long hepatocellular carcinoma (HCC) surveillance is recommended after sustained virological response (SVR) in patients with advanced hepatitis C. Since the identification of patients who could be safely discontinued for surveillance is essential, we aimed to identify subsets of patients with low-risk HCC.
491 patients with advanced and compensated fibrosis (≥F3) were prospectively followed after achieving SVR with interferon-free therapies. Clinical-biological parameters and liver stiffness measurement (LSM) were performed before starting treatment (ST) and at SVR, and HCC surveillance was carried out.
During a median follow-up of 49.8 months, 29 (5.9%) patients developed HCC [incidence rate: 1.6/100 patient-years (PYs)]. Two predictive models based on LSM (Model-A) or FIB-4 score (Model-B) were proposed. Only SVR parameters were included in the models, because they showed a higher accuracy for predicting HCC than ST measurements. Variables independently associated with HCC were LSM (HR, 1.03; 95% CI, 1.01-1.05), age (HR, 1.04; 95% CI, 1.01-1.08) and albumin levels (HR, 0.90; 95% CI, 0.84-0.97) in Model-A, and FIB-4 (HR, 1.22; 95% CI, 1.08-1.37) and albumin (HR, 0.90; 95% CI, 0.84-0.97) in model-B. Both models allow HCC risk stratification, identifying low-risk groups with an HCC incidence rate of 0.16/100 and 0.25/100 PYs, respectively. An overall increased hazard of HCC was observed over time.
Simple models based on non-invasive markers of liver fibrosis, LSM or FIB-4, together with age and albumin levels at SVR permit to identify subsets of patients with HCC risk clearly <1%/year, for whom HCC surveillance might not be cost-effective.
慢性丙型肝炎患者获得持续病毒学应答（SVR）后，建议进行终生肝癌（HCC）监测。由于确定可以安全停止监测的患者至关重要，因此我们旨在确定 HCC 低风险患者亚组。
491 例接受无干扰素治疗后获得 SVR 的晚期和代偿性纤维化（≥F3）患者前瞻性随访。在开始治疗（ST）前和 SVR 时进行临床生物学参数和肝脏硬度测量（LSM），并进行 HCC 监测。
在中位随访 49.8 个月期间，29 例（5.9%）患者发生 HCC[发生率：1.6/100 患者年（PYs）]。提出了两种基于 LSM（模型-A）或 FIB-4 评分（模型-B）的预测模型。仅包括 SVR 参数，因为它们对预测 HCC 的准确性高于 ST 测量。与 HCC 独立相关的变量是 LSM（HR，1.03；95%CI，1.01-1.05）、年龄（HR，1.04；95%CI，1.01-1.08）和白蛋白水平（HR，0.90；95%CI，0.84-0.97）在模型-A 中，FIB-4（HR，1.22；95%CI，1.08-1.37）和白蛋白（HR，0.90；95%CI，0.84-0.97）在模型-B 中。两种模型均允许进行 HCC 风险分层，分别确定 HCC 发生率为 0.16/100 和 0.25/100 PYs 的低风险组。随着时间的推移，观察到 HCC 的总体风险增加。
基于 LSM 或 FIB-4 以及 SVR 时的年龄和白蛋白等非侵入性肝纤维化标志物的简单模型可确定 HCC 风险明显<1%/年的患者亚组，对于这些患者，HCC 监测可能没有成本效益。
