Transient elastography and fibrosis-4 index as predictors of hepatocellular carcinoma in hepatitis C virus patients with sustained virological response.

BACKGROUND

People with compensated advanced chronic liver disease (cACLD) remain at high risk of hepatocellular carcinoma (HCC) even after hepatitis C virus (HCV) sustained virological response (HCV-SVR).

AIM: To evaluate transient elastography and fibrosis-4 (FIB-4) index as prognostic markers for HCC after HCV-SVR.

METHODS

This retrospective cohort study analyzed data from people with cALCD and HCV-SVR. cALCD was defined as baseline liver stiffness measurement (LSM) ≥ 10 kPa. The primary outcome was the occurrence of HCC. Data collected at baseline (pre-treatment) and 1 year after the end of treatment (1-year-EOT) of LSM, FIB-4 index, and laboratory results were analyzed. LSM and FIB-4 index were evaluated as independent predictors of HCC by a Cox regression analysis. Receiver operator characteristic curves, Kaplan-Meier curves, and Cox regression analysis were performed.

RESULTS

Total of 425 patients (65.2% female; mean age = 62 ± 10 years) were included. The median pre-treatment and 1-year-EOT LSM were respectively 15.0 kPa (interquartile range: 11.8-23.2) and 12 kPa (interquartile range: 7.9-19.9) (P < 0.001), with a 27% (interquartile range: 2.7%-43%) reduction after SVR. The median pre-treatment FIB-4 index was 2.94 (interquartile range: 1.89-4.85) and 1-year-EOT FIB-4 1.99 (interquartile range: 1.29-3.13) (P < 0.001). Neither LSM nor FIB-4 deltas were associated with HCC. A total of 26 participants (6%) developed HCC during a follow-up of 48 ± 23 months with an incidence of 15.3/1000 person-years. Age [hazard ratio (HR) = 1.06, 95% confidence interval (CI): 1.01-1.11; P = 0.02], baseline (HR = 1.05, 95%CI: 1.02-1.07) and 1-year-EOT LSM ≥ 20 kPa (HR = 4.49, 95%CI: 2.19-9.19; P < 0.001) and baseline (HR = 7.79, 95%CI: 2.31-26.32; P < 0.001) and 1-year-EOT FIB-4 index score ≥ 3.25 (HR = 3.14, 95%CI: 1.65-6.00; P < 0.001) were associated with incident HCC.

CONCLUSION

In cACLD-HCV SVR patients, pre-treatment or 1-year-EOT LSM ≥ 20 kPa and FIB-4 ≥ 3.25 but not their delta was associated with HCC. A single measure of LSM ≥ 20 kPa or FIB-4 ≥ 3.25, either pre-treatment or 1-year-EOT, would be necessary to predict the incidence of HCC in people with HCV-SVR.