부산대학교 도서관

Background & Aims: Patients with chronic hepatitis C and stage 3 fibrosis are thought to remain at risk of hepatocellular carcinoma after sustained virological response. We investigated this risk in a large cohort of patients with well‐defined stage 3 fibrosis. Methods: We performed a multicentre, ambispective, observational study of chronic hepatitis C patients with sustained virological response after treatment with direct‐acting antivirals started between January and December 2015. Baseline stage 3 was defined in a two‐step procedure: we selected patients with transient elastography values of 9.5‐14.5 kPa and subsequently excluded those with nodular liver surface, splenomegaly, ascites or collaterals on imaging, thrombopenia or esophago‐gastric varices. Patients were screened twice‐yearly using ultrasound. Results: The final sample comprised 506 patients (median age, 57.4 years; males, 59.9%; diabetes, 17.2%; overweight, 44.1%; genotype 3, 8.9%; HIV coinfection, 18.4%; altered liver values, 15.2%). Median follow‐up was 33.7 (22.1‐39.1) months. Five hepatocellular carcinomas and 1 cholangiocarcinoma were detected after a median of 29.4 months (95% CI: 26.8‐39.3), with an incidence of 0.47/100 patients/year (95% CI: 0.17‐1.01). In the multivariate analysis, only males older than 55 years had a significant higher risk (hazard ratio 7.2 [95% CI: 1.2‐41.7; P =.029]) with an incidence of 1.1/100 patients/year (95% CI: 0.3‐2.8). Conclusions: In a large, well‐defined cohort of patients with baseline hepatitis C stage‐3 fibrosis, the incidence of primary liver tumours was low after sustained virological response and far from the threshold for cost‐effectiveness of screening, except in males older than 55 years. [ABSTRACT FROM AUTHOR]