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Predictors of hepatocellular carcinoma in HCV cirrhotic patients treated with direct acting antivirals.

  • Authors: Lleo A1, Aglitti A2, Aghemo A1, Maisonneuve P3, Bruno S1, Persico M4; Rendina M5, Ciancio A6, Lampertico P7, Brunetto MR8, Di Marco Vito, Zuin M10, Andreone P11, Villa E12, Troshina G6, Degasperi E7, Coco B13, Calvaruso Vincenza, Giorgini AM10, Conti F11, Di Leo A5, Marzi L12, Boccaccio V14, Bollani S15, Colombo M16.
  • Publication year: 2018
  • Type: Articolo in rivista (Articolo in rivista)
  • OA Link:


Background: Despite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs),the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial. Aim: To prospectively assess the risk of HCC occurrence and early recurrence in a large cohort of DAAtreated HCV-cirrhotic patients and to identify potential predictors of HCC development. Methods: We analyzed data prospectively collected from 1927 consecutive HCV-infected cirrhotic patients treated with DAA from January to December 2015 in 10 tertiary liver centers in Italy and followed-up for one year after therapy. 161 patients had a previous HCC. Results: 38/161 subjects developed tumor recurrence during the follow-up (recurrence rate = 24.8 per 100-year), patients with SVR had a significantly lower rate of recurrence. Lack of SVR and alphafetoprotein (AFP) were independent predictors of HCC recurrence. 50/1766 patients without a previous HCC history developed HCC during follow-up (incidence rate = 2.4 per 100-year). Lack of SVR was the strongest predictor of HCC development. Furthermore, patients with SVR and no stigmata of portal hypertension have a lower incidence rate of HCC (1.0 per 100-year). Conclusions: SVR is associated with a significant decrease of recurrent or de novo HCC. Baseline AFP and signs of portal hypertension can help to stratify the risk of HCC. © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved