Profiling the risk of hepatocellular carcinoma after long-term HCV eradication in patients with liver cirrhosis in the PITER cohort
Loreta A. Kondili, Maria Giovanna Quaranta, Luisa Cavalletto, Vincenza Calvaruso, Luigina Ferrigno, Roberta D’Ambrosio, Ilaria Simonelli, Giuseppina Brancaccio, Giovanni Raimondo, Maurizia Rossana Brunetto, Anna Linda Zignego, Carmine Coppola, Andrea Iannone, Elisa Biliotti, Gabriella Verucchi, Marco Massari, Anna Licata, Francesco Barbaro, Marcello Persico, Francesco Paolo Russo, Filomena Morisco, Maurizio Pompili, Mauro Viganò, Massimo Puoti, Teresa Santantonio, Erica Villa, Antonio Craxı̀, Liliana Chemello, Valentina Panetta, Giovanni Battista Gaeta, Roberto Filomia, B. Coco, Monica Monti, Daniela Caterina Amoruso, Salvatore Madonia, Donatella Ieluzzi, Gloria Taliani, Lorenzo Badia, Guglielmo Marco Migliorino, Alessia Giorgini, Mario Masarone, Pierluigi Blanc, Valentina Cossiga, Martina De Siena, Xhimi Tata, Maria Grazia Rumi, Luchino Chessa, Pietro Lampertico, Carlo Ferrari, Ivan Gentile, Giustino Parruti, Leonardo Baiocchi, Alessia Ciancio, Pietro Invernizzi, Alessandro Federico, Carlo Torti, Giulia Morsica, Pietro Andreoné, Alessio Aghemo, Patrizia Popoli, Stefano Vella
Abstract
BACKGROUND AND AIMS: Severe liver disease markers assessed before HCV eradication are acknowledged to usually improve after the SVR. We prospectively evaluated, in the PITER cohort, the long-term HCC risk profile based on predictors monitored after HCV eradication by direct-acting antivirals in patients with cirrhosis. METHODS: HCC occurrence was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the post-treatment variables associated with de-novo HCC; their predictive power was presented in a nomogram. RESULTS: After the end of therapy (median follow-up:28.47 months), among 2064 SVR patients, 119 (5.8%) developed de-novo HCC. The HCC incidence was 1.90%, 4.21%, 6.47% at 12-, 24- and 36-months from end-of-therapy, respectively (incidence rate 2.45/100 person-years). Age, genotype 3, diabetes, platelets (PLT)≤120,000/µl and albumin ≤3.5g/dl levels were identified as pre-treatment HCC independent predictors. Adjusting for age, the post-treatment PLT≤120,000/µl (AdjHR 1.92; 95%CI:1.06-3.45) and albumin≤3.5g/dl (AdjHR 4.38; 95%CI 2.48-7.75) values were independently associated with HCC occurrence. Two different risk profiles were identified by combining long-term post-therapy evaluation of PLT ≤ vs. >120,000/µl and albumin ≤ vs. >3.5g/dl showing a significant different HCC incidence rate of 1.35 vs. 3.77/100 p-y, respectively. CONCLUSIONS: The nomogram score based on age, PLT and albumin levels after SVR showed an accurate prediction capability and may support the customizing management for early HCC detection.