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: 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. Results: 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: 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.
Zamparelli, M. S., Lens, S., Sapena, V., Llarch, N., Pla, A., Iserte, G., … Mariño, Z. (2019). 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. Journal of Hepatology, 70(1), e845. https://doi.org/10.1016/s0618-8278(19)31689-5