| We AIMed to prospectively investigate real incidence and determinants of HCC after SVR in HCV-related liver diseases. Patients and Methods: Patients who achieved SVR12 between Jan 1, 2015 and Jan 31, 2017 were enrolled under IRB-proven protocol at 15 institutions, including 10 universities and 5 high-volume centers in Kyushu. Cox proportional hazards model was used to determine significant risk factors for HCC occurrence after SVR. Results: 3,471 patients, consisting of 3,012 who did not have previous HCC (group A, GA) and 459 who had HCC but cured by surgery or ablation therapy prior to DAA treatment (group B, GB), were subjected to the analysis. During a median follow-up period of over 2.2 years, 70 patients (2.7%) in GA and 217 (47.2%) in GB developed de novo and de novo/recurrent HCC, respectively. The 1-, 2-, and 3-year cumulative HCC incidence were 1.3%, 2.9%, and 4.9%, respectively, in GA, and 27.1%, 43.4%, and 50.8% in GB. The factors for HCC risk in GA were GGT level >44 IU/L (p<0.0001), FIB-4 index >4.6 (p<0.0001), age > 62 (years old, p<0.0008), and presence of diabetes mellitus (p<0.04), and those in GB were ≥2 sessions in pre-DAA HCC treatment (p<0.0054) and pre-DAA AFP level >5.4 ng/mL (p<0.0001). Forty-five patients in GA having all 4 risk factors showed 9.1% of 1-year HCC incidence. Conclusion: DAA-induced SVR dose not always warrant long HCC-free status thereafter. Post-DAA follow up needs special attention to the above-mentioned risk factors. |
