Patients who were cured of the hepatitis C virus (HCV) still faced a risk for liver cancer, researchers said, but new surveillance models seemed to help manage that risk.
In one study, researchers followed 2,326 patients with chronic HCV, who had advanced cirrhosis or liver fibrosis, and applied a scoring system to them. Despite HCV elimination, the highest at-risk group still had a 10.3% risk of developing cancer over the next 2 years, according to Gamal Shiha, MBBCH, MD, PhD, Mansoura University in Mansoura, Egypt.
Additionally, the risk of hepatocellular carcinoma (HCC) in people with a medium score was 4.5% over 2 years and those with a low-score had a 2% risk of developing the disease after 2 years, he said in a presentation at the digital Internal Liver Congress, the annual meeting of the European Association for the Study of the Liver (EASL).
Shiha said that previous studies have suggested that liver cancer surveillance of people with HCV-related liver damage would be cost-effective if the risk was higher than 1.5%, and that his group's study indicates that most people -- but not all -- who achieve HCV eradication with direct-acting antivirals have a low risk.
"Currently, there is convincing evidence that earlier stage detection of hepatocellular carcinoma through surveillance is more amenable to curative therapies and improved overall survival," he said.
Shiha and colleagues factored age, sex, serum albumin, serum alpha fetoprotein, and pretreatment fibrosis stage to develop a scoring system called the GES. They then determined various cutoffs on the system to put patients in risk categories.
In a separate study done at Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, similar techniques were used to develop another scoring system, explained Jessica Azzi, PharmD, of the ANRS C022 HEPATHER research group.
The researchers analyzed HCV patient data from 32 centers (n=21,007 patients) and eventually evaluated 3,926 patients who had undergone direct-acting antiviral therapy and achieved a sustained virologic response.
Of that group, 205 individuals were diagnosed with HCC. Also, 2,829 were diagnosed with cirrhosis, and 191 of them later developed HCC. Finally, 1,097 patients were diagnosed with advanced liver fibrosis and 15 were later diagnosed with HCC, Azzi reported.
Using various demographic and disease factors, the researchers devised a cutoff for high, medium, and low risk at 2 years, with the low-risk group having a 2.17% risk for developing liver cancer, the medium group a 7.59% risk, and the high group a 25% risk.
"This study identifies a high-risk subgroup of patients in which screening would be cost-effective," Azzi said during an EASL presentation.
Shiha noted that the surveillance models need to be studied prospectively before they can be routinely integrated into clinical practice.
"These studies reflect the complexity of understanding hepatocarcinogenesis and refute the idea that cure of hepatitis C virus is equal to eliminating the risk of liver cancer," commented Jordi Bruix, MD, of the Hospital Clinic of Barcelona/University of Barcelona, in a statement.
"The proposed scores potentially represent a useful clinical tool to help inform patients about the risk of developing hepatocellular carcinoma after hepatitis C virus is cured," added Bruix, an EASL governing board member. "These data also reinforce the importance of implementing a hepatocellular carcinoma screening program in direct acting antiviral-treated patients and the need to reinforce research efforts to identify the causes of liver cancer development despite cure."
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