Persistence of hepatocellular carcinoma risk in hepatitis c patients with a response to ifn and cirrhosis regression

2018 Liver International In Press;

BACKGROUND AND AIM: In patients with HCV-related cirrhosis, a SVR may lead to cirrhosis regression. Whether histological changes translate into prevention of long-term complications, particularly hepatocellular carcinoma (HCC) is still unknown. This was investigated in a cohort of histological cirrhotics who had been prospectively followed-up for 10 years after the achievement of a SVR to IFN. METHODS: 38 SVR cirrhotics who underwent a liver biopsy (LB) 5 years post-SVR were prospectively followed to assess the impact of cirrhosis regression on clinical endpoints. RESULTS: During a follow-up of 86 (30-96) months from LB, no patients developed clinical decompensation, whilst 5 (13%) developed HCC after 79 (7-88) months. The 8-year cumulative probability of HCC was 17%, without differences between patients with or without cirrhosis regression [19% (95% CI 6-50%) vs. 14% (95% CI 4-44%), p=0.88]. Patients who developed or did not an HCC had similar rates of residual cirrhosis (p=1.0), collagen content (p=0.48), METAVIR activity (p=0.34), portal inflammation (p=0.06) and steatosis (p=0.17). At baseline, patients who developed an HCC had higher gammaGT (HR 1.03, 95% CI 1.00-1.06; p=0.014) and glucose (HR 1.02, 95% CI 1.00-1.02; p=0.012) values; moreover, they had increased Forns Score (HR 12.8, 95% CI 1.14-143.9; p=0.039), Lok Index (HR 6.24, 95% CI 1.03-37.6; p=0.046) and PLF (HR 19.3, 95% CI 1.72-217.6; p=0.016) values. One regressor died of lung cancer. The 8-year cumulative survival probability was 97%, independently on cirrhosis regression (96% vs. 100%, p=1.0) or HCC (100% vs. 97%, p=1.0). CONCLUSIONS: Post-SVR cirrhosis regression does not prevent HCC occurrence. This article is protected by copyright. All rights reserved.