Hepatocellular carcinoma in the setting of interferon-free treatment for chronic HCV hepatitis - experience of a single center

Abstract

Aim: This study aims to analyze the particularities of hepatitis C induced hepatocellular carcinoma (HCC), developed during or after treatment with direct-acting antivirals.

Methods: We conducted an observational prospective study on 278 patients, who underwent treatment for hepatitis C related liver cirrhosis and respectively for F3 chronic hepatitis C. Liver status was assessed using biological parameters and imagistic evaluation (ultrasonography, computed tomography scan, magnetic resonance imaging).

Results: The follow-up time was 14 months. Before therapy, 69.3% of the cirrhotic patients and 26.7% of those with F3 degree of liver fibrosis had high levels of alpha-fetoprotein, with no imagistic evidence of HCC. During treatment, HCC was confirmed in 5 patients, 2 of them presenting portal vein thrombosis (PVT). Antiviral therapy was not interrupted. Two patients developed HCC at the end of treatment, while 4 of them were diagnosed with HCC after three months of ending the treatment. Excepting the ones with PVT, all patients underwent trans-arterial chemoembolization.

Conclusion: All patients acquired sustained virological response. The screening for HCC should not be stopped after achievement of sustained virological response. Patients who develop HCC after antiviral treatment often need to be evaluated by magnetic resonance imaging in order to detect the extension of the disease.

Keywords

Hepatitis C virus / direct-acting antiviral therapy / hepatocellular carcinoma / trans-arterial chemoembolization

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