In the Journals

Albumin, liver stiffness after DAA therapy for HCV stratify liver cancer risk

Albumin levels and liver stiffness measurements taken during direct-acting antiviral therapy follow-up can stratify liver cancer risk among patients with hepatitis C and compensated advanced chronic liver disease, according to study results.

“Due to their safety profile and low side effects, any patient in any stage of chronic liver disease (from mild fibrosis to decompensated cirrhosis) can be treated with DAA,” Mònica Pons, MD, from the Vall d'Hebron Research Institute in Barcelona, Spain, and colleagues wrote. “Therefore, it is important to know which patients will be prone to develop liver-related complications, such as hepatocellular carcinoma (HCC) or liver decompensation, and will need a lifelong follow up and which ones will have a good prognosis so they could be safely discharged from follow up.”

The study comprised 1,563 patients who underwent DAA therapy, including 572 patients with compensated advanced chronic liver disease. The SVR rate was 97.1%.

During a median follow-up of 2.9 years, the most frequent liver-related event was HCC, which occurred in 25 patients for an incidence rate of 1.5 per 100 patient-years. The median time to HCC occurrence was 1 year (range, 0.4-3.3 years).

Multivariate analysis showed that albumin levels at baseline (HR = 0.29; 95% CI, 0.11-0.76) and albumin levels (HR = 0.08; 95% CI, 0.02-0.25) and liver stiffness less than 10 kPa (HR = 0.33; 95% CI, 0.11-0.96) measured at follow-up were independently associated with risk for HCC during follow-up.

Pons and colleagues combined follow-up albumin and liver stiffness measurements to develop a risk identification model according to predictors gathered at 1 year after finishing treatment.

“We identified two main risk groups, a low-risk group and a high-risk group, of presenting with HCC, with different estimates of HCC incidence,” they wrote.

A Cox regression model constructed using either albumin less than 4.4 or 4.4 and higher along with liver stiffness measurements of less than 10 kPa, between 10 kPa and 20 kPa, and 20 kPa or higher demonstrated good predictive power (Harrell’s C index = 0.73).

The researchers noted that although patients with liver stiffness measurements less than 10 kPa at follow-up have a low risk for HCC, a “zero-risk” subpopulation cannot be found, and HCC surveillance needs to be considered for all patients.

“However, with the information provided by our study, patients and clinicians will possess the right information about the expected risk of HCC on an individual basis and more importantly, it will serve to stress the importance of continuing HCC screening (especially in the high-risk groups) and maintaining adherence to these programs by the patients,” they concluded. – by Talitha Bennett

Disclosures: Pons reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Albumin levels and liver stiffness measurements taken during direct-acting antiviral therapy follow-up can stratify liver cancer risk among patients with hepatitis C and compensated advanced chronic liver disease, according to study results.

“Due to their safety profile and low side effects, any patient in any stage of chronic liver disease (from mild fibrosis to decompensated cirrhosis) can be treated with DAA,” Mònica Pons, MD, from the Vall d'Hebron Research Institute in Barcelona, Spain, and colleagues wrote. “Therefore, it is important to know which patients will be prone to develop liver-related complications, such as hepatocellular carcinoma (HCC) or liver decompensation, and will need a lifelong follow up and which ones will have a good prognosis so they could be safely discharged from follow up.”

The study comprised 1,563 patients who underwent DAA therapy, including 572 patients with compensated advanced chronic liver disease. The SVR rate was 97.1%.

During a median follow-up of 2.9 years, the most frequent liver-related event was HCC, which occurred in 25 patients for an incidence rate of 1.5 per 100 patient-years. The median time to HCC occurrence was 1 year (range, 0.4-3.3 years).

Multivariate analysis showed that albumin levels at baseline (HR = 0.29; 95% CI, 0.11-0.76) and albumin levels (HR = 0.08; 95% CI, 0.02-0.25) and liver stiffness less than 10 kPa (HR = 0.33; 95% CI, 0.11-0.96) measured at follow-up were independently associated with risk for HCC during follow-up.

Pons and colleagues combined follow-up albumin and liver stiffness measurements to develop a risk identification model according to predictors gathered at 1 year after finishing treatment.

“We identified two main risk groups, a low-risk group and a high-risk group, of presenting with HCC, with different estimates of HCC incidence,” they wrote.

A Cox regression model constructed using either albumin less than 4.4 or 4.4 and higher along with liver stiffness measurements of less than 10 kPa, between 10 kPa and 20 kPa, and 20 kPa or higher demonstrated good predictive power (Harrell’s C index = 0.73).

The researchers noted that although patients with liver stiffness measurements less than 10 kPa at follow-up have a low risk for HCC, a “zero-risk” subpopulation cannot be found, and HCC surveillance needs to be considered for all patients.

“However, with the information provided by our study, patients and clinicians will possess the right information about the expected risk of HCC on an individual basis and more importantly, it will serve to stress the importance of continuing HCC screening (especially in the high-risk groups) and maintaining adherence to these programs by the patients,” they concluded. – by Talitha Bennett

Disclosures: Pons reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.