Abstract: Chronic infection with hepatitis C virus (HCV) may complicate with hepatocellular carcinoma (HCC), especially in patients with cirrhosis. Although the achievement of a sustained virological response (SVR) had been associated with a reduction in the risk of HCC already in the Interferon era, some concerns initially raised following the use of direct-acting antivirals (DAA), as their use was associated with increased risk of HCC development and aggressiveness. However, studies demonstrated that the risk of HCC was strongly influenced by pre-treatment fibrosis stage and, eventually, prior HCC history more than the type of antiviral therapy. According to published studies, rates of de-novo HCC ranged between 1.4% and 13.6% in patients with cirrhosis or advanced fibrosis vs 0.9% and 5.9% in those with chronic hepatitis C (CHC). Conversely, rates of recurrent HCC were higher, ranging between 3.2% and 49% in cirrhotics vs 0% and 40% in CHC patients. Most studies tried to identify predictors of HCC development, either de-novo or recurrent, and some authors were also able to build predictive scores for HCC risk stratification, which however still need prospective validation. Whereas some clinical features, such as age, gender, presence of comorbidities and fibrosis stage, may influence both de-novo and recurrent HCC, previous tumour burden before DAA seems to prevail over these features in recurrent HCC risk prediction.

Keywords: hepatocellular carcinoma, HCC, hepatitis C virus, HCV, sustained virological response, SVR, direct-antiviral agent, DAA, surveillance, predictor


中文翻译：

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预测慢性 HCV 感染和直接作用抗病毒药物持续病毒学反应患者的肝细胞癌风险


摘要：慢性丙型肝炎病毒（HCV）感染可能并发肝细胞癌（HCC），尤其是肝硬化患者。尽管在干扰素时代，实现持续病毒学应答 (SVR) 与 HCC 风险降低相关，但在使用直接作用抗病毒药物 (DAA) 后最初引起了一些担忧，因为它们的使用与HCC 发展和侵袭性的风险增加。然而，研究表明，治疗前纤维化阶段以及既往 HCC 病史对 HCC 风险的影响比抗病毒治疗类型的影响更大。根据已发表的研究，肝硬化或晚期纤维化患者的新发 HCC 发生率在 1.4% 至 13.6% 之间，而慢性丙型肝炎 (CHC) 患者的新发 HCC 发生率在 0.9% 至 5.9% 之间。相反，肝硬化患者的 HCC 复发率较高，为 3.2% 至 49%，而 CHC 患者的复发率为 0% 至 40%。大多数研究试图确定 HCC 发展的预测因素，无论是新发还是复发，一些作者还能够建立 HCC 风险分层的预测评分，但这仍然需要前瞻性验证。尽管年龄、性别、合并症的存在和纤维化阶段等一些临床特征可能会影响新发 HCC 和复发性 HCC，但在复发性 HCC 风险预测中，DAA 之前的既往肿瘤负荷似乎优于这些特征。


关键词：肝细胞癌、HCC、丙型肝炎病毒、HCV、持续病毒学应答、SVR、直接抗病毒药物、DAA、监测、预测