Page 56 - 台灣肝癌醫學冬季會手冊-1222-V3_Neat

Liver stiffness and fibrosis-4 score at sustained virological response in hepatoma
risk assessment for chronic hepatitis C patients after direct-acting antivirals

Yuan-Hung Kuo, Jing-Houng Wang, Chao-Hung Hung, Chien-Hung Chen, Tsung-Hui Hu,
Sheng-Nan Lu
Division of Hepato-Gastroenterology, Department of Internal Medicine

Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan

OBJECTIVES: Chronic hepatitis C (CHC) patients after direct antiviral agents remained at risk of
hepatocellular carcinoma (HCC). This study was to determine whether liver stiffness (LS) and

fibrosis-4 score (FIB-4) were useful in assessing HCC risk for CHC patients after direct-acting
antivirals (DAA).
METHODS: This retrospective study enrolled CHC patients achieving SVR after DAA. Those with
LS measurement and complete lab data at SVR were followed and analyzed. The demographics,

clinical characteristics and HCC development were obtained from medical chart reviews. The
diagnosis of HCC was based on recommended criteria.
RESULTS: A total of 703 (M/F: 296/407, mean age: 63.8 year) patients were enrolled. The median
follow-up period was 2.24 years. Twenty-eight patients (M/F:13/15, mean age: 65.6 years) developed

HCC. The 3-year cumulative HCC incidence was 5.8 %. The performance of LS and FIB-4 in
predicting HCC occurrence as assessed by area under receiver operating curve was 0.775 and 0.739.
The optimal cutoff was 11kPa and 3.6 for LS and FIB-4, obtained with Youden’s index. Multivariate
analysis showed LS>=11kPa (hazard ratio:2.695, 95% confidence interval: 1.069-6.792, p=0.036)

and FIB-4 >=3.6 (3.068, 1.352-6.962, p=0.007) were independently associated with HCC
development. The 3-year cumulative rate of HCC development was 18.2% for patients with
LS>=11kPa and FIB-4>=3.6, while it was 2.5% for those without (log-rank p-value: <0.001).
CONCLUSIONS: For CHC patients achieving SVR after DAA, LS and FIB-4 was useful in HCC

risk assessment. Patients with both LS>=11kPa and FIB-4>=3.6 at SVR had the highest risk of HCC
development.