Liver Stiffness Measurement Is Useful to Predict Early Recurrence of Hepatocellular Carcinoma after Sustained Virological Responses by Direct Antiviral Agents in Patients with Hepatitis C
Background: Recently, increases
in the risk of Hepatocellular carcinoma (HCC) recurrence in patients with
hepatitis C virus (HCV) due to the administration of direct antivirals agents
(DAA) have been reported. Methods: One hundred and nineteen patients who
were treated with DAA and achieved sustained viral response (SVR) were
prospectively followed-up for over two years by transient elastography with
liver stiffness measurements (LSM). Fourteen out of 119 patients (12%) had a
history of being treated for HCC by radiofrequency ablation or resection and
achieved complete responses after previous HCC treatments before the initiation
of DAA. HCC was diagnosed by contrast-enhanced computed tomography (CT) or
enhanced magnetic resonance imaging (MR). CT or MR was performed before the DAA
treatment and every 6 months after during the follow-up. LSM was performed at
the initiation of DAA (LSM0), at 24 weeks after the start of DAA (LSM24), at 48
weeks after that (LSM48) and at 2 years
after that (LSM2y). Results: LSM0, LSM24, LSM48 and LSM2y of 105 patients
without HCC were 7.5 (3.027.0), 6.0 (2.5 - 31.6), 4.6 (2.6？- 25.2) and 4.4 (3.1- 29.9) kPa, respectively, showing significant improvements. Three out of
105 patients (2.9%) subsequently developed HCC and their LSM showed
improvements. Eight out of fourteen patients (57%) with a history of HCC
treatments subsequently developed HCC recurrence. LSM0 in the eight patients
with recurrence increasing from 12.1 to 27.0 kPa,
LSM24 from 9.9 to 26.6 kPa and LSM48 from 9.6 to 18.0 kPa. On the other hand,
the six other patients without recurrence had LSM values that were less than
12.0 kPa at last. Based on the ROC analysis, LSM0 15.4, LSM24 12.8 and LSM48
9.6 kPa were identified as cut-off values. Conclusion: HCV patients
previously treated for HCC with high LSM values before and after DAA have an
elevated risk of HCC recurrence, particularly LSM24 >12.8 kPa and LSM48 >9.6 kPa.
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