Editor's Note: Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis and hepatocellular carcinoma (HCC). In recent years, the treatment of HCV infection has undergone revolutionary changes, transforming chronic HCV infection into a curable disease. Although direct-acting antiviral (DAA) therapy can effectively clear HCV, improve liver fibrosis, and reduce the risk of HCC, certain factors such as age, liver fibrosis, metabolic diseases, genetic factors, and treatment regimens still put some patients at high risk for HCC even after HCV clearance. A recent study on the long-term prognosis of patients with advanced chronic liver disease post-HCV cure reveals that these patients continue to face risks of hepatic decompensation and HCC. This finding is crucial for developing long-term management strategies for cured HCV patients.1. Research Background
It is estimated that by 2030, approximately 750,000 HCV patients worldwide will achieve viral clearance through treatment annually. However, for patients with compensated advanced chronic liver disease (cACLD), the risk of further liver function deterioration remains even after HCV clearance. This study aimed to assess the long-term prognosis of patients with advanced chronic liver disease post-HCV cure and to evaluate the predictive efficacy of existing HCC risk stratification models.
2. Key Findings
The research team conducted a retrospective analysis of data from 2,335 cACLD patients across 15 European centers. The median age was 60.2±11.9 years, with 21.1% being obese and 21.2% having diabetes. All patients had successfully cleared HCV through DAA therapy. The study found that over an average follow-up period of six years:
- 84 patients (3.6%) experienced their first hepatic decompensation, with an incidence rate of 0.74% per year and a six-year cumulative incidence of 3.2%.
- 183 patients (7.8%) developed new-onset HCC, with an incidence rate of 1.60% per year and a six-year cumulative incidence of 8.3%.
The study indicated that the risks of hepatic decompensation and new-onset HCC increased linearly over time.
The study also validated the effectiveness of the Baveno VII criteria in predicting the risk of hepatic decompensation. This standard assesses clinical significant portal hypertension (CSPH) presence through liver stiffness measurement (LSM) and platelet count (PLT), aiding in patient risk stratification.
Additionally, the study examined the predictive ability of existing HCC risk stratification algorithms in post-HCV cure patients. Although these algorithms could identify high-risk and low-risk groups, the proportion of low-risk groups varied significantly across studies (9.9%-69.1%). To address this, the research team developed a more refined “HCC-SVR” model to provide individualized HCC risk predictions.
3. Conclusions and Implications
Researchers concluded that in cACLD patients cured of HCV, the risks of hepatic decompensation and new-onset HCC remain constant even during long-term follow-up (over three years). This finding suggests that risk stratification based on non-invasive criteria post-treatment can provide significant prognostic information, which remains valid in long-term follow-up.
The study emphasizes the importance of long-term management for patients with advanced chronic liver disease post-HCV cure. Clinicians should develop individualized follow-up and treatment plans based on patients’ risk stratification results to ensure timely intervention and improve prognosis. Further research is needed to validate the accuracy of existing risk stratification algorithms and to explore new predictive markers to optimize patient management strategies.
