Treatment-induced liver stiffness reduction lowers HCC risk in HBV patients
medwireNews: Achieving a subcirrhotic liver stiffness (sc-LS) level after antiviral therapy (AVT) halves the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV)-related advanced fibrosis or cirrhosis, Korean research shows.
This “may help physicians to modify surveillance strategies according to on-treatment LS responses to AVT in this population,” Seung Up Kim (Yonsei University College of Medicine, Seoul) and co-authors remark.
The findings were based on a study of 209 patients (median age 51 years, 66% men) with chronic HBV-related advanced fibrosis or cirrhosis who underwent paired transient elastography (TE) before and after 2 years of AVT with entecavir (66.5%), telbivudine (15.8%), lamivudine (8.1%), adefovir (3.8%), tenofovir (3.8%), or clevudine (1.9%).
At baseline, the median LS value was 14.1 kPa, and 38.8% of patients were within the sc-LS range (<11.6 kPa). After 2 years of AVT, this proportion increased to 67.0%.
The majority (92.6%) of patients with sc-LS at enrolment maintained this status after 2 years of AVT, while half (50.8%) of those within the cirrhotic range (≥11.6 kP) at baseline achieved sc-LS by the end of treatment.
During a median follow-up period of 62.2 months, 28 (13.4%) patients developed HCC.
The researchers report in Gastroenterology and Hepatology that achieving sc-LS after AVT was independently associated with a significant 51.5% reduction in risk for developing HCC in a multivariate analysis (p=0.047).
By contrast, older age and male sex were both associated with an increased risk for HCC at hazard ratios of 1.07 and 3.70, respectively (p<0.05 for both).
Kim et al say: “[O]ur study showed that TE can be useful for monitoring changes in the fibrotic burden of patients with [chronic HBV]-related advanced fibrosis or cirrhosis undergoing AVT, and provided an easy-to-use therapeutic target of AVT-induced sc-LS, which was associated with better long-term outcomes (reflected by HCC development) in this study population.”
However, they caution: “Because the risk of HCC development cannot be eliminated due to the underlying fibrotic burden, appropriate surveillance should not be ignored in spite of fibrosis regression, reflected by the achievement of sc-LS after 2 years of AVT.”
And the researchers conclude that “further studies are needed to define more precisely the role of non-invasive methods in monitoring fibrosis regression, and to confirm that incorporation of TE into the surveillance strategy during AVT is beneficial and cost-effective.”
By Laura Cowen
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