Necessity for surveillance for hepatocellualr carcinoma in older patients with chronic hepatitis C who achieved sustained virological response

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) surveillance in low‐risk patients (annual incidence <1.5%) is not recommended per the American Association for the Study of Liver Diseases guidelines. Because patients with chronic hepatitis C with non‐advanced fibrosis who have achieved sustained virological response (SVR) have a low risk of HCC, HCC surveillance is not recommended for them. However, aging is a risk factor for HCC; threfore, the necessity for HCC surveillance in older patients with non‐advanced fibrosis needs to be verified. METHODS: This multicenter, prospective study enrolled 4993 patients with SVR (1998 patients with advanced fibrosis and 2995 patients with non‐advanced fibrosis). The HCC incidence was examined with particular attention to age. RESULTS: The 3‐year incidence of HCC in patients with advanced and non‐advanced fibrosis was 9.2% (95% CI: 7.8–10.9) and 2.9% (95% CI: 2.1–3.7), respectively. HCC incidence was significantly higher in patients with advanced fibrosis (P < 0.001). HCC incidence stratified by age and sex was investigated in patients with non‐advanced fibrosis. The HCC incidence in the 18–49, 50s, 60s, 70s, and ≥80 age groups were 0.26, 1.3, 1.8, 1.7, and 2.9 per 100 person‐years in men, and 0.00, 0.32, 0.58, 0.49, and 0.57 per 100 person‐years in women, respectively. CONCLUSIONS: Male patients with non‐advanced fibrosis aged ≥60 years have a higher risk of developing HCC and, thus, require HCC surveillance.