Hepatocellular carcinoma screening is indicated even after sustained virological response: -Moroccan University Hospital Experience-

Abstract

Introduction: Hepatitis C is the first aetiologic agent for HCC in Morocco. Antiviral treatment reduces the risk of developing HCC in patients with chronic hepatitis C but few cases of HCC have been still reported. We aimed to define population with high risk of HCC occurrence, confirm the protective role of SVR and to identify predictive factors of developing HCC after SVR. We'll try to present suggestions about screening strategies (indications and interval) after antiviral therapy according to level of HCC occurrence risk. Patients and Methods: We included all patients with chronic hepatitis C treated in our department from January 2002 to April 2010. We compare HCV-treated patients with no developed HCC to HCC population using khi-2 and Fisher Exact analysis. Results: 369 patients treated for hepatitis C were considered, and 20 HCC were reported. The risk of HCC occurrence was not significant according to gender and genotypes. Advanced age and severe fibrosis were significant risk factors. HCC was reported in 2.3% of sustained virological responders versus 12.5% of non responders. SVR is a significant protective factor. Conclusion: In our series, 5% of previously treated HCV carriers developed HCC and 2.3% of sustained virological responders developed. Achieving SVR after antiviral therapy is a protective factor. Advanced age (> 50 y. o), severe fibrosis (F>2) and lack of SVR at HCV diagnosis are predictive factors of HCC development in treated patients. Regular bi-annual ultrasonography screening should be indicated necessarily in patients with advanced fibrosis stage (F3- F4) even after SVR, particularly when co-morbid conditions are associated (advanced age, NASH, diabetes mellitus,...). Screening interval in sustained virological responders with reduced fibrosis stage may be limited to annual surveillance. Establishing guidelines about consensual strategy to survey sustained virological responders is now necessary especially with high rates of SVR and the extension of treatment indications in era of DAA drugs. Keywords: Hepatocellular Carcinoma (HCC), Screening, Sustained Virological Response (SVR)