In those without cirrhosis, diabetes and Hypertension They also play a role in the risk of hepatocellular carcinoma.
This paper highlights the need for patients who have been treated Hepatitis C virus Infections and pre-existing cirrhosis should be monitored over time to check for changes in their blood work that may indicate an increased risk of liver cancer,” Michael E. DeBakey Medical Center told Veterans Affairs in Houston, Texas. Medscape Medical News.
“Also, patients with HCV infection who do not have cirrhosis but who have diabetes and high blood pressure have not yet cleared HCC, and should be followed up by their physician as well,” she added.
study was Posted online in American Journal of Gastroenterology.
Calculation of the main risk factors
Kramer and colleagues conducted a retrospective cohort study of 9,2567 patients with hepatitis C infection, who achieved a sustained virological response using direct-acting antivirals. They examined patients who visited one of the 130 Veterans Administration hospitals during 2014-2018 and were followed up through 2021.
The research team analyzed associations between demographic, clinical, and behavioral factors and HCC risk, measuring this at baseline and after 12 and 24 months of sustained virological response.
Of the 92567 patients, 27% were diagnosed with cirrhosis before infection with HCV. In addition, 5.5% had a Fibrosis-4 (FIB-4) value greater than 3.25, 36.7% had diabetes, 83.1% had hypertension, 51.2% had dyslipidemia, and 14.1% They are active. alcohol use disturbance. The median age was 61 years, and it was 96% of the men.
Overall, 3,247 HCCs were diagnosed during an average of 2.5 years of follow-up. Of these, 2404 (74%) were diagnosed in patients with cirrhosis at baseline.
Among the 29,398 patients with cirrhosis, the cumulative incidence of HCC was 2.0% at 1 year, 3.8% at 2 years, and 5.4% at 3 years.
The risk was significantly lower in 63,169 patients without cirrhosis, of whom 843 were diagnosed with HCC. The risk was 0.2% at 1 year, 0.5% at 2 years, and 0.8% at 3 years.
In patients with cirrhosis, the risk of developing liver cancer was higher in men, smokers, those with hepatitis C genotype 3 and those who had had 5 or more years since the diagnosis of cirrhosis. The risk was lower in African American patients.
In addition, serum bilirubinAnd the albuminThe presence of varicose veins, and higher FIB-4 scores are associated with hepatocellular carcinoma risk. For the latter variable, the risk was 2.5-fold higher in patients with cirrhosis whose FIB-4 score was above 3.25 versus those with FIB-4 scores below 1.45.
Over time, most of the associations observed at baseline persisted at the 12- and 24-month points, with some notable exceptions, the study authors wrote. For example, the presence of ascites was associated with an increased risk of HCC at both of these follow-up times.
There was also a strong association between HCC risk and changes in serum albumin, bilirubin and FIB-4 scores. A one-unit increase in serum bilirubin between baseline and 24 months was associated with a 22% increase in cancer risk.
The risk of HCC was approximately two times higher in patients with high FIB-4 scores at the time of viral treatment and 24 months, compared with patients with persistently low FIB-4 scores. In addition, the risk was 81% higher in patients with low baseline scores who rose to high scores at 24 months.
In patients without cirrhosis, people with high blood pressure and diabetes had a 1.5 times greater risk of developing HCC than their peers. After controlling for diabetes and hypertension, there were no differences between patients with a body mass index (BMI) of 30 or higher and those with a body mass index of 25-30. In contrast, the risk was higher in patients with a BMI of less than 25, with the highest risk being in patients with a BMI of less than 18.5.
In addition, baseline serum albumin scores and FIB-4 scores were associated with HCC risk. Patients with a baseline FIB-4 score between 1.45 and 3.25 had a 2.3-fold higher risk than those with a low score. Previous failure to treat hepatitis C, genotype 3, and current smoking were also associated with a higher risk in patients without cirrhosis.
Putting these results into practice
The study authors write that making risk assessments based on repeated measurements at 24 months is “practical and could improve joint decision-making between patients and their physicians.”
“We are all struggling to determine the best way to screen for HCC over time after an ongoing virological response in patients with and without cirrhosis,” said George Ioannou, MD, professor of medicine at the University of Washington. Medscape Medical News.
Ioannou, who was not involved in this study, also serves as the director of hepatology at the Puget Sound Veterans Affairs Healthcare System. He and colleagues found that the risk of developing liver cancer persists up to 10 years after hepatitis C resection, particularly in patients with primary cirrhosis and high FIB-4 scores.
“This study offers some insights, especially since changes in risk factors over time should be studied carefully,” he said. “Further work will be required to operationalize an approach for estimating HCC risk after an ongoing virological response in individual patients.”
In addition, Kramer suggested measures to address major risk factors before they develop into an underlying condition.
“All adults over the age of 18 should be screened for hepatitis C virus infection, even without symptoms, as it can be easily treated before cirrhosis develops,” she said.
The study was based on work supported by the Department of Defense and supported by the National Cancer Institute, the Texas Institute for Cancer Prevention and Research, the Veterans Administration’s Center for Innovations in Quality, Efficacy, and Safety, and Michael E. DeBakey VA Medical and the Center for Development of the Digestive System, Infection and Injury. The book did not mention any conflicts of interest. Ioannou has not reported any relevant disclosures.
I J Gastroenterol. Posted online August 23, 2022. Summary
Caroline Krist is a health and medical journalist reporting on the latest studies for Medscape, MDedge, and WebMD.