Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness
Background & Aims: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We a...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | JHEP Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555921000653 |
| _version_ | 1818448281359876096 |
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| author | Elton Dajti Giovanni Marasco Federico Ravaioli Luigi Colecchia Alberto Ferrarese Davide Festi Antonio Colecchia |
| author_facet | Elton Dajti Giovanni Marasco Federico Ravaioli Luigi Colecchia Alberto Ferrarese Davide Festi Antonio Colecchia |
| author_sort | Elton Dajti |
| collection | DOAJ |
| description | Background & Aims: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs. Methods: This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development. Results: During a median follow-up of 41.5 (IQR 32–49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001–1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 ≤10 kPa were at the lowest risk of HCC. In patients with LSM-SVR24 >10 kPa, HCC incidence was not further influenced by LSM values (10–20 kPa vs. >20 kPa), but only by SSM-SVR24 values (≤42 vs. >42 kPa). Conclusions: Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement. Lay summary: Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals. |
| first_indexed | 2024-12-14T20:17:01Z |
| format | Article |
| id | doaj.art-3136bfe66d9046499eaf538726d0f1d6 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-12-14T20:17:01Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-3136bfe66d9046499eaf538726d0f1d62022-12-21T22:48:50ZengElsevierJHEP Reports2589-55592021-06-0133100289Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffnessElton Dajti0Giovanni Marasco1Federico Ravaioli2Luigi Colecchia3Alberto Ferrarese4Davide Festi5Antonio Colecchia6IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyIRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyUnit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, ItalyDepartment of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, ItalyUnit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy; Corresponding author. Address: Unit of Gastroenterology, Borgo Trento University Hospital, P. le Aristide Stefani 1, 37126, Verona, Italy.Background & Aims: Hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs) reduces but does not eliminate the risk for hepatocellular carcinoma (HCC). The development of surveillance strategies for HCC after the sustained virologic response (SVR) is therefore warranted. We aimed to evaluate the role of spleen stiffness measurement (SSM) in the prediction of HCC risk in a cohort of patients with advanced chronic liver disease (ACLD) treated with DAAs. Methods: This is a retrospective cohort study of 140 patients with HCV-related ACLD successfully treated with DAAs in our centre between 2015 and 2017. Patients with available liver stiffness (LSM) and SSM before treatment and 6 months after (SVR24) were included. A Cox regression model investigated the association between SSM and HCC development. Results: During a median follow-up of 41.5 (IQR 32–49) months, 20 patients presented with HCC. SSM at SVR24 predicted HCC development in univariate and adjusted multivariate analysis (hazard ratio: 1.025; 95% CI: 1.001–1.050); the best cut-off was 42 kPa. Patients with LSM-SVR24 ≤10 kPa were at the lowest risk of HCC. In patients with LSM-SVR24 >10 kPa, HCC incidence was not further influenced by LSM values (10–20 kPa vs. >20 kPa), but only by SSM-SVR24 values (≤42 vs. >42 kPa). Conclusions: Portal hypertension, as evaluated by SSM, plays a significant role in liver carcinogenesis after DAA treatment. We proposed a new algorithm based on post-treatment values of LSM and SSM for the stratification of HCC risk after SVR achievement. Lay summary: Spleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals.http://www.sciencedirect.com/science/article/pii/S2589555921000653Spleen stiffnessLiver stiffnessTransient elastographyHCCDAADirect-acting antiviral |
| spellingShingle | Elton Dajti Giovanni Marasco Federico Ravaioli Luigi Colecchia Alberto Ferrarese Davide Festi Antonio Colecchia Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness JHEP Reports Spleen stiffness Liver stiffness Transient elastography HCC DAA Direct-acting antiviral |
| title | Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness |
| title_full | Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness |
| title_fullStr | Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness |
| title_full_unstemmed | Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness |
| title_short | Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness |
| title_sort | risk of hepatocellular carcinoma after hcv eradication determining the role of portal hypertension by measuring spleen stiffness |
| topic | Spleen stiffness Liver stiffness Transient elastography HCC DAA Direct-acting antiviral |
| url | http://www.sciencedirect.com/science/article/pii/S2589555921000653 |
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