Lack of reduction of serum alphafetoprotein during treatment with direct antiviral agents predicts hepatocellular carcinoma development in a large cohort of patients with hcv-related cirrhosis

Risk of HCC in HCV cirrhotic patients treated with DAA is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow up of 17.3 months after EOT, including 943 patients without history of HCC and 102 previously treated for HCC. The majority were males (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan Meier curves were performed to detect predictors of HCC in patients with and without reduction in AFP during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54/943 (5.7%) occurrent and 41/102 (39%) recurrent tumors. De-novo were more often unifocal (p=0.01) and curable (p=0.03). AFP decreased from 16.1 ± 36.2 mg/dl (baseline) to 11.4 ± 55 mg/dl (EOT). At univariate analysis, predictors were a previous HCC, older age, higher MELD, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction of AFP during treatment. Kaplan Meier curves showed lower incidence of HCC in patients showing any reduction of AFP (p=0.001). Those with AFP <6 ng/ml had the lowest risk (p=0.0002). At logistic regression, platelets (p=0.009, OR 0.99 CI: 0.99-1.00), previous HCC (p<0.00001, OR: 10.76, 95% CI: 5.89-19.34), and no reduction of AFP during treatment (p=0.0005, OR: 2.98, CI: 1.60-5.54) were independent predictors of HCC. In conlusion, risk of HCC after DAA treatment remains substantial. It's higher among patients with previous HCC, low platelets and without reduction of AFP during treatment. This article is protected by copyright. All rights reserved.