ArticleGastroenterology2019
Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients With Baseline Cirrhosis or High FIB-4 Scores.
Article in Gastroenterology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 188 papers, 7 of them syntheses that pooled it.
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Who cites it
188 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- AGA Clinical Practice Update on Risk Stratification and Emerging Surveillance Strategies for Hepatocellular Carcinoma: Expert Review.Gastroenterology · 2026Guideline
- Serum M2BPGi as a predictor of hepatocellular carcinoma development in chronic hepatitis B and C: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-analysis.Clinical and molecular hepatology · 2024Pooled it
- Risk of Hepatocellular Carcinoma After Spontaneous Clearance of Hepatitis C Virus and in Noncirrhosis Chronic Hepatitis C Patients With Sustained Virological Response: A Systematic Review.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Pooled it
- HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta-analysis.Hepatology (Baltimore, Md.) · 2022Pooled it
- Efficacy and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Liver Disease: a Meta-Analysis and Systematic Review.Cardiovascular drugs and therapy · 2021Pooled it
- Multiparametric Ultrasound in Chronic Viral Hepatitis: From Fibrosis and Portal Hypertension to Steatosis and Focal Lesion Characterisation.Diagnostics (Basel, Switzerland) · 2026Review
- Validation of Risk Models for Predicting Post-SVR HCC in Real-World Surveillance Across Global Geographic Regions.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- The Regeneration Paradox in Liver Cancer: How Chronic Injury Transforms Healing into Carcinogenesis.Liver cancer · 2026Review
- Repeated measurements of alpha fetoprotein and fibrosis-4 predict long term hepatocellular carcinoma and mortality risks after antiviral therapy.Infectious medicine · 2026Article
- Risk of Hepatocellular Carcinoma After Direct-Acting Antiviral Treatment for Hepatitis C Virus Infection in People With HIV.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- From Cure to Complexity: Post-SVR Liver and Metabolic Trajectories in Diabetic Patients.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Rising Cardiometabolic Comorbidity and Inpatient Resource Utilization Among Hospitalized Patients with Hepatocellular Carcinoma, 2018-2022.Journal of clinical medicine · 2026Article
- Growth differentiation factor 15: from stress response to clinical utility in chronic liver diseases.Journal of gastroenterology · 2026Review
- Practice changing RCT design and rationale: Abbreviated MRI plus AFPJHEP reports : innovation in hepatology · 2026Review
- Chrono-optimal treatments for human immunodeficiency virus/hepatitis C virus co-infection yield comparable survival outcomes with hepatitis C virus mono-infection.World journal of gastroenterology · 2026Article
- Retrospective Analysis of Diagnostic and Prognostic Value of Serum Glypican-3 in Patients With HCV-Related Cirrhosis With Or Without HCC After Achieving SVR With DAA Treatment.Journal of gastrointestinal cancer · 2026Observational
- Risk Scores for Stratifying Hepatocellular Carcinoma and Optimizing Surveillance Strategies.Cancers · 2026Review
- Rates and Factors Associated With Hepatocellular Carcinoma Diagnosis, Stage, Treatment, and Survival.Gastro hep advances · 2026Article
128 more citing papers are in PubMed but not listed here.
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Authors and funding
11 authors.
Funding
Abstract
BACKGROUND &
aimsIt is unclear if hepatocellular carcinoma (HCC) risk declines over time after hepatitis C virus (HCV) eradication. We analyzed changes in HCC annual incidence over time following HCV eradication and identified dynamic markers of HCC risk.
methodsWe identified 48,135 patients who initiated HCV antiviral treatment from 2000 through 2015 and achieved a sustained virologic response (SVR) in the Veterans Health Administration (29,033 treated with direct-acting antiviral [DAA] agents and 19,102 treated with interferon-based regimens). Patients were followed after treatment until February 14, 2019 (average 5.4 years), during which 1509 incident HCCs were identified.
resultsAmong patients with cirrhosis before treatment with DAAs (n = 9784), those with pre-SVR fibrosis-4 (FIB-4) scores ≥3.25 had a higher annual incidence of HCC (3.66%/year) than those with FIB-4 scores <3.25 (1.16%/year) (adjusted hazard ratio 2.14; 95% confidence interval 1.66-2.75). In DAA-treated patients with cirrhosis and FIB-4 scores ≥3.25, annual HCC risk decreased from 3.8%/year in the first year after SVR to 2.4%/year by the fourth year (P=.01). In interferon-treated patients with FIB-4 scores ≥3.25, annual HCC risk remained above 2%/year, even 10 years after SVR. A decrease in FIB-4 scores from ≥3.25 pre-SVR to <3.25 post-SVR was associated with an approximately 50% lower risk of HCC, but the absolute annual risk remained above 2%/year. Patients without cirrhosis before treatment (n = 38,351) had a low risk of HCC, except for those with pre-SVR FIB-4 scores ≥3.25 (HCC risk 1.22%/year) and post-SVR FIB-4 scores ≥3.25 (HCC risk 2.39%/year); risk remained high for many years after SVR.
conclusionsPatients with cirrhosis before an SVR to treatment for HCV infection continue to have a high risk for HCC (>2%/year) for many years, even if their FIB-4 score decreases, and should continue surveillance. Patients without cirrhosis but with FIB-4 scores ≥3.25 have a high enough risk to merit HCC surveillance, especially if FIB-4 remains ≥3.25 post-SVR.
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