The risks of first hepatic decompensation and HCC remain constant during long-term follow-up and can be stratified by a one-time assessment after HCV-cure

Background  More than 1 million patients/year will be cured from HCV infection for the next decade. In those with compensated advanced chronic liver disease(cACLD), the risks of hepatocellular carcinoma (HCC) and hepatic decompensation are decreased but not completely abolished by HCV-cure. Thus, risk stratification is key to decrease resource utilization. We evaluated whether the incidences of HCC and hepatic decompensation decrease with time after HCV-cure and whether the discriminatory ability of a one-time post-treatment assessment is maintained during long-term follow-up.

Methods  We retrospectively analyzed cACLD patients with paired liver stiffness measurement (LSM) & platelet count (PLT) before and after HCV-cure by interferon-free therapies from 15 European centers. Cumulative incidence curves were used to estimate the incidence of hepatic decompensation/HCC over time in the overall group and throughout previously defined risk strata.

Results  2347 patients (mean age 60±12 years, 60% male, 21% diabetes) with a median LSM of 16.3kPa (IQR: 12.1-24.5, 25% ≥25kPa) before HCV-cure were followed for a median of 6.0years after treatment. The incidence of first hepatic decompensation was strictly linear with 65 patients (2.8%) developing hepatic decompensation before eventually being diagnosed with HCC (incidence rate 0.57/100 patient-years, incidence at 6 years:3.1%). Similarly, incidence of HCC was also linear with 184 patients (7.8%) developing HCC (incidence rate 1.60/100 patient-years, incidence at 6 years:8.3%). Stratifying the risks for hepatic decompensation according to Baveno-VII and for HCC according to Semmler et al (algorithm based on age, LSM, albumin and alcohol consumption) after HCV-cure identified subgroups with a distinct prognosis during long-term follow-up, even after limiting prediction to events occurring >3 years after HCV-cure.

Conclusions  In patients with cACLD, the risks of hepatic decompensation, and more importantly, HCC remain constant after HCV-cure, even in the long-term (>3 years). A one-time post-treatment risk stratification based on non-invasive criteria confers important prognostic information that is maintained during long-time follow-up.

Publication History

Article published online:
24 May 2023