Liver cancer risk decreases after hepatitis C treatment

According to the results of a study published in Gastroenterology. But even after seven years, the risk remains high enough to warrant continued screening for hepatocellular carcinoma in some groups.

Over years or decades, chronic hepatitis C virus (HCV) can lead to serious complications, including cirrhosis of the liver, liver cancer and the need for a liver transplant. Treatment with direct-acting antivirals (DAAs) can cure more than 90% of people with hepatitis C, reducing the risk of hepatocellular carcinoma (HCC), the most common type of liver cancer. However, the risk of liver cancer may persist in people who have already progressed to advanced liver fibrosis or cirrhosis by the time they receive HCV treatment.

George Ioannou, MD, of Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues previously found that during the first four years following sustained virological response (SVR) to DAA therapy, the annual incidence of HCC was greater than 2% in people who had cirrhosis before antiviral treatment. The incidence of HCC was greater than 1% in people with severe fibrosis but not yet progressing to cirrhosis. SVR means an undetectable viral load 12 weeks after the end of antiviral treatment, which is considered a cure.

While the annual risk of liver cancer fell during the first four years after treatment, follow-up in this study did not last long enough to determine whether the risk drops enough to eliminate further screening. The American Association for the Study of Liver Diseases recommends that people with cirrhosis should be monitored for HCC using ultrasound, with or without blood biomarker testing, every six months.

In a new study, Ioannou and his colleagues conducted a longer follow-up of seven years for the same cohort of people cured with antiviral treatment. They sought to understand the annual risk of liver cancer and its relationship to cirrhosis and fibrosis scores. Would risk levels decrease enough to eliminate screening for hepatocellular carcinoma?

Researchers analyzed the electronic health records of 29,033 veterans with HCV who achieved SVR between January 2013 and December 2015. Almost all participants were male, 52% were Caucasian, and the average age was 61 years old. Some 44% had alcohol use disorders, 38% had substance use disorders and 29% had diabetes.

Of these participants, 7,533 had cirrhosis before receiving antivirals. Of the 21,500 people without cirrhosis before treatment, 4,682 had high fibrosis scores at baseline. These people were followed until December 2021.

Annual liver cancer incidence rates fell from 3.8% in the first year of follow-up to 1.4% in the seventh year for people with a high fibrosis score who achieved SVR . Regardless of improvements in fibrosis scores after HCV treatment, people with cirrhosis remained more likely to develop liver cancer even after being cured. Over a five-year period, 12.6% of people who had cirrhosis before treatment developed liver cancer, compared to only 2.5% of those who did not have cirrhosis.

People with high fibrosis scores, even in the absence of cirrhosis, had a greater incidence of liver cancer than people with lower scores. Additionally, those who lowered their scores after treatment reduced their risk of liver cancer to a much greater degree than those who maintained a high score after treatment.

For people with both cirrhosis and high fibrosis scores, the annual incidence of HCC ranged between 0.7% and 1.3%, with little or no improvement over time. In these people, continued screening for hepatocellular cancer may still be necessary, the study authors concluded.

Click here to read the summary of the study in Gastroenterology.
Click here for more information on the treatment of hepatitis C.

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