Hepatitis C: HCC risk despite cure?

Modern drugs make it possible to cure patients with hepatitis C infection in many cases. While successful treatment significantly reduces the risk of hepatocellular carcinoma (HCC), the risk is not zero.

HCV cure does not reduce HCC risk to zero

• Despite successful treatment of hepatitis C, some patients with liver cirrhosis have a higher risk of hepatocellular carcinoma (HCC). 
• The incidence of HCC increases with age and with decompensated cirrhosis.
• The longer it has been since the hepatitis C infection was cured, the lower the incidence of HCC.

Guidelines so far are unclear about follow-up duration

In line with guidelines, surveillance is recommended especially in populations where HCC incidence is greater than 1.5% per year. Even in the case of liver cirrhosis, HCC surveillance should be continued after HCV recovery. However, the duration of this measure is unclear at present.

In addition, the guidelines make inconsistent recommendations, e.g. for patients with advanced fibrosis (F3). A recent meta-analysis therefore compared HCC incidences after HCV cure in patients with F3 fibrosis and with cirrhosis.

HCC incidence decreases over time after HCV cure

In total, the researchers identified 44 studies with 107,548 person-years of follow-up. All studies investigated HCC incidence after HCV cure in patients with F3 fibrosis or cirrhosis.

Results showed that HCC incidence in patients with liver cirrhosis was 2.1 per 100 person-years (95% CI: 1.9-2.4). In contrast, the incidence of HCC in patients with F3 fibrosis was only 0.5 per 100 person-years (95% CI: 0.3-0.7).

In patients with cirrhosis, older age (aRR: 1.32; 95% CI: 1.00-1.73) and previous decompensation (aRR: 1.06; 95% CI: 1.01-1.12) were also associated with a higher incidence of HCC.

Furthermore, HCC incidence decreased with increasing length of follow-up after HCV cure (aRR per year of follow-up: 0.87; 95% CI: 0.79-0.96).

What do these data mean for medical practice?

Even in the era of HCV cure using modern treatment regimens, the risk of hepatocellular carcinoma (HCC) in cirrhotic patients is not zero. However, as time progresses after HCV cure, the risk of HCC in cirrhotic patients decreases. In addition, the incidence of HCC is lowest in patients of younger age and in those with compensated cirrhosis.

There is still a lack of validated predictive models to identify at-risk individuals - especially when it comes to patients with F3 fibrosis. The researchers conclude that the incidence of HCC after HCV cure in patients with F3 fibrosis is even lower than the recommended threshold for cost-effective screening in follow-up.

Further coverage on oncology and gastroenterology

• esanum's Congress Page: UEG Week 2022
• esanum's Congress Page: ESMO 2022