SAT-482-Incidence of hepatocellular carcinoma after hepatitis C cure with DAA in a cohort of patients with advanced liver disease: Results from a prospective screening program

Marco Sanduzzi Zamparelli, Sabela Lens, Víctor Sapena, Neus Llarch, Anna Pla, Gemma Iserte, Concepció Bartres, Ramón Vilana, Luis Bianchi, Nuñez Isabel, Anna Darnell, Ernest Belmonte, Carmen Ayuso, Maria Ángeles García-Criado, Alba Díaz, Carla Fuster, Ferran Torres, Jordi Bruix, Xavier Forns, María ReigZoe Mariño

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Background and aims: Although HCV cure with DAA (> 95%)is associated with a reduced risk of disease progression, the impact of DAA on hepatocellular carcinoma (HCC)occurrence is controversial. The aim of this study was to estimate HCC incidence after DAA in a cohort of patients with advanced liver disease by a prospective screening program. Method(s): Prospective study including HCV-infected patients with cirrhosis or advanced fibrosis (F3, TE >= 9.5Kpa), without previous history of HCC, cured after DAA; patients should have a US imaging in <30 days from inclusion excluding the presence of HCC or non-characterized nodules. All patients were evaluated every 6 months. Follow-up (FU)time was censored at the moment of event (HCC)or September 2018. HCC incidence was expressed in 100/patients-year (100PY)(IC95%). Adherence to screening was assessed. Result(s): 275 patients signed inform consent; 90 patients were excluded (mainly due the absence of pre-DAA US in <30 days); 185 patients were analysed: 52.4% men, age 65.1 [55.1-72]years. 34% (n = 63)patients were F3 (TE 11.5[10.1-12.1]KPa)vs 122 (65.9%)patients with cirrhosis (TE 18[14.3-26.6]Kpa): 87.7% Child-A, 17.2% history of decompensation, 40.9% varices in endoscopy, 39.3% TE >= 21Kpa. Adherence to screening program was 98.4% and 7 incident HCC were detected after a median clinical and radiological time of 27.5[24.7-33.9]and 23.9[23.4-24]months, respectively. Median time from SVR to HCC diagnosis was 24.5[17.3-30.7]months. Overall incidence of HCC was 2.01/100PY [IC95%: 0.9-4.2]. All HCC cases occurred in cirrhotic patients (incidence: 3.04/100PY [IC95%: 1.4-6.3])with TE >= 21KPa (incidence in subgroup: 5, 93/100PY [IC95%: 2.9-11.8]. The 7 HCC cases [BCLC-0 (n = 3)/A (n = 3)/C (n = 1)]received specific treatment [percutaneous (n = 4), surgery (n = 1), TACE (n = 1); sorafenib (n = 1)]; 2 patients presented recurrence/HCC progression after 2.3 and 2.04 months of oncologic treatment. During FU, 7 patients died (3.78%), one due to HCC progression. Conclusion(s): Risk of HCC persists in cirrhosis even if SVR is achieved with DAA (3.04/100PY). In this cohort, we did not identify any HCC in F3 patients (although the number of patients is limited). Moreover, in this specific cohort of patient without non-characterized nodules at baseline we did not find a time-association of HCC and DAA. Altogether, screening programs to rule out HCC are necessary in patients with cirrhosis achieving SVR; this risk should be further investigated in larger cohorts of F3 patients.Copyright © 2019 European Association for the Study of the Liver
Original languageEnglish
Pages (from-to)e845
JournalJ. Hepatol.
Issue number1
Publication statusPublished - Apr 2019

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