Cargando…

Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study

Background and aims: The identification of patients with Hepatitis C Virus (HCV)-positive advanced chronic liver disease (aCLD) successfully treated by Direct Acting Antiviral Agents (DAAs) who really benefit from Hepatocellular Carcinoma (HCC) surveillance programs is still a matter of debate. We p...

Descripción completa

Detalles Bibliográficos
Autores principales: Ciancio, Alessia, Ribaldone, Davide Giuseppe, Spertino, Matteo, Risso, Alessandra, Ferrarotti, Debora, Caviglia, Gian Paolo, Carucci, Patrizia, Gaia, Silvia, Rolle, Emanuela, Sacco, Marco, Saracco, Giorgio Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856119/
https://www.ncbi.nlm.nih.gov/pubmed/36672675
http://dx.doi.org/10.3390/biomedicines11010166
_version_ 1784873544970141696
author Ciancio, Alessia
Ribaldone, Davide Giuseppe
Spertino, Matteo
Risso, Alessandra
Ferrarotti, Debora
Caviglia, Gian Paolo
Carucci, Patrizia
Gaia, Silvia
Rolle, Emanuela
Sacco, Marco
Saracco, Giorgio Maria
author_facet Ciancio, Alessia
Ribaldone, Davide Giuseppe
Spertino, Matteo
Risso, Alessandra
Ferrarotti, Debora
Caviglia, Gian Paolo
Carucci, Patrizia
Gaia, Silvia
Rolle, Emanuela
Sacco, Marco
Saracco, Giorgio Maria
author_sort Ciancio, Alessia
collection PubMed
description Background and aims: The identification of patients with Hepatitis C Virus (HCV)-positive advanced chronic liver disease (aCLD) successfully treated by Direct Acting Antiviral Agents (DAAs) who really benefit from Hepatocellular Carcinoma (HCC) surveillance programs is still a matter of debate. We performed a long-term prospective cohort study on F3-F4 HCV-positive patients achieving Sustained Virologic Response (SVR) after DAAs treatment in order to identify patients who can safely suspend surveillance. Methods: 1000 patients with HCV-positive aCLD obtaining SVR by DAAs from January 2015 to December 2017 were divided into four groups according to baseline elastographic, ultrasonographic, clinical and biochemical features: (1) Group 1: 324 patients with Liver Stiffness Measurement (LSM) ≥ 9.5 ≤ 14.5 kPa, FIB-4 < 3.25 and APRI < 1.5 (2) Group 2: 133 patients with LSM ≥ 9.5 ≤ 14.5 kPa, FIB-4 ≥ 3.25 and/or APRI ≥ 1.5 (3) Group 3: 158 patients with LSM > 14.5 kPa, FIB-4 < 3.25 and APRI < 1.5 (4) Group 4: 385 patients with LSM > 14.5 kPa, FIB-4 ≥ 3.25 and/or APRI ≥ 1.5. FIB-4 and APRI scores were calculated at baseline and at SVR achievement. Each patient was surveiled twice-yearly by ultrasound for a median follow-up of 48 months. Results: among Group 1 patients, 1/324 (0.3%) developed HCC (0.09/100 patients/year [PY]), compared to 6/133 (4.5%) Group 2 patients (1.22/100 PY, p = 0.0009), 10/158 (6.3%) Group 3 patients (1.68/100 PY, p = 0.0001), 54/385 (14.0%) Group 4 patients (4.01/100 PY, p < 0.0001). HCC incidence was significantly lower in Group 2 compared to Group 3 (p = 0.004) and in Group 3 compared to Group 4 (p = 0.009). HCC risk fell in patients showing a decrease of FIB-4/APRI scores. Conclusions: the risk of HCC occurrence is negligible in about 90% of HCV-positive patients with baseline LSM ≥ 9.5 ≤ 14.5 kPa plus FIB-4 < 3.25 and APRI < 1.5 achieving SVR. Among this particular subset of patients, FIB-4/APRI scores may represent an accurate and inexpensive tool to distinguish patients not needing long-term HCC surveillance.
format Online
Article
Text
id pubmed-9856119
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-98561192023-01-21 Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study Ciancio, Alessia Ribaldone, Davide Giuseppe Spertino, Matteo Risso, Alessandra Ferrarotti, Debora Caviglia, Gian Paolo Carucci, Patrizia Gaia, Silvia Rolle, Emanuela Sacco, Marco Saracco, Giorgio Maria Biomedicines Article Background and aims: The identification of patients with Hepatitis C Virus (HCV)-positive advanced chronic liver disease (aCLD) successfully treated by Direct Acting Antiviral Agents (DAAs) who really benefit from Hepatocellular Carcinoma (HCC) surveillance programs is still a matter of debate. We performed a long-term prospective cohort study on F3-F4 HCV-positive patients achieving Sustained Virologic Response (SVR) after DAAs treatment in order to identify patients who can safely suspend surveillance. Methods: 1000 patients with HCV-positive aCLD obtaining SVR by DAAs from January 2015 to December 2017 were divided into four groups according to baseline elastographic, ultrasonographic, clinical and biochemical features: (1) Group 1: 324 patients with Liver Stiffness Measurement (LSM) ≥ 9.5 ≤ 14.5 kPa, FIB-4 < 3.25 and APRI < 1.5 (2) Group 2: 133 patients with LSM ≥ 9.5 ≤ 14.5 kPa, FIB-4 ≥ 3.25 and/or APRI ≥ 1.5 (3) Group 3: 158 patients with LSM > 14.5 kPa, FIB-4 < 3.25 and APRI < 1.5 (4) Group 4: 385 patients with LSM > 14.5 kPa, FIB-4 ≥ 3.25 and/or APRI ≥ 1.5. FIB-4 and APRI scores were calculated at baseline and at SVR achievement. Each patient was surveiled twice-yearly by ultrasound for a median follow-up of 48 months. Results: among Group 1 patients, 1/324 (0.3%) developed HCC (0.09/100 patients/year [PY]), compared to 6/133 (4.5%) Group 2 patients (1.22/100 PY, p = 0.0009), 10/158 (6.3%) Group 3 patients (1.68/100 PY, p = 0.0001), 54/385 (14.0%) Group 4 patients (4.01/100 PY, p < 0.0001). HCC incidence was significantly lower in Group 2 compared to Group 3 (p = 0.004) and in Group 3 compared to Group 4 (p = 0.009). HCC risk fell in patients showing a decrease of FIB-4/APRI scores. Conclusions: the risk of HCC occurrence is negligible in about 90% of HCV-positive patients with baseline LSM ≥ 9.5 ≤ 14.5 kPa plus FIB-4 < 3.25 and APRI < 1.5 achieving SVR. Among this particular subset of patients, FIB-4/APRI scores may represent an accurate and inexpensive tool to distinguish patients not needing long-term HCC surveillance. MDPI 2023-01-09 /pmc/articles/PMC9856119/ /pubmed/36672675 http://dx.doi.org/10.3390/biomedicines11010166 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ciancio, Alessia
Ribaldone, Davide Giuseppe
Spertino, Matteo
Risso, Alessandra
Ferrarotti, Debora
Caviglia, Gian Paolo
Carucci, Patrizia
Gaia, Silvia
Rolle, Emanuela
Sacco, Marco
Saracco, Giorgio Maria
Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title_full Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title_fullStr Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title_full_unstemmed Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title_short Who Should Not Be Surveilled for HCC Development after Successful Therapy with DAAS in Advanced Chronic Hepatitis C? Results of a Long-Term Prospective Study
title_sort who should not be surveilled for hcc development after successful therapy with daas in advanced chronic hepatitis c? results of a long-term prospective study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856119/
https://www.ncbi.nlm.nih.gov/pubmed/36672675
http://dx.doi.org/10.3390/biomedicines11010166
work_keys_str_mv AT ciancioalessia whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT ribaldonedavidegiuseppe whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT spertinomatteo whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT rissoalessandra whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT ferrarottidebora whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT cavigliagianpaolo whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT caruccipatrizia whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT gaiasilvia whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT rolleemanuela whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT saccomarco whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy
AT saraccogiorgiomaria whoshouldnotbesurveilledforhccdevelopmentaftersuccessfultherapywithdaasinadvancedchronichepatitiscresultsofalongtermprospectivestudy