Approximately 95% of patients with chronic hepatitis C achieve viral eradication through direct-acting antiviral (DAA) treatment. Ensuing clinical benefits include halting liver fibrosis, thereby reducing the need for liver transplantation, and decreasing both liver-related and overall mortality. It is well established that, although ameliorated, the risk of developing hepatocellular carcinoma (HCC) persists, particularly among patients with pre-treatment advanced fibrosis/cirrhosis. Current guidelines recommend indefinite HCC surveillance in these patients. However, a recent Markov model evaluation shows that HCC surveillance is cost-effective only for patients with cirrhosis but not so for those with F3 fibrosis, a finding which points out the need to better define the risk of HCC in hepatitis C patients after cure and further characterize pre- and post-treatment factors that might affect the incidence of HCC in this setting. We reviewed the literature analyzing this aspect. Here we summarize the main findings: male gender and older age are independent predictors of increased risk of post-cure HCC development. Moreover, non-invasive tests for hepatic fibrosis, namely FIB4, APRI, and liver stiffness, measured before and after treatment and their post-therapy change, contribute to better stratifying the risk of HCC occurrence. Furthermore, low serum albumin, as well as an AFP above 7 ng/mL prior to and after DAA therapy, also constitute independent predictors of HCC development. Considering these findings, we propose to classify patients with HCV viral eradication and advanced fibrosis/cirrhosis into groups of low, medium, or high risk of HCC and to adopt adequate surveillance strategies for each group, including protocols for abbreviated magnetic resonance imaging (MRI) for those at the highest risk.
约95%的慢性丙型肝炎患者通过直接抗病毒药物治疗实现病毒清除。随之而来的临床获益包括阻止肝纤维化进展、降低肝移植需求，并减少肝脏相关及全因死亡率。现有研究明确表明，尽管风险有所降低，但肝细胞癌的发生风险依然存在，特别是在治疗前已存在晚期肝纤维化/肝硬化的患者中。现行指南建议对此类患者进行无限期肝细胞癌监测。然而，近期一项马尔可夫模型评估显示，肝细胞癌监测仅对肝硬化患者具有成本效益，对F3级纤维化患者则不然。这一发现指出，有必要更精准地界定丙型肝炎治愈后患者的肝细胞癌风险，并进一步明确可能影响肝细胞癌发生的治疗前后相关因素。我们系统回顾了相关文献，现将主要发现总结如下：男性与高龄是治愈后肝细胞癌发生风险增加的独立预测因素。此外，治疗前后进行的肝纤维化无创检测（包括FIB4、APRI及肝脏硬度值）及其治疗后的动态变化，有助于更精确地分层评估肝细胞癌发生风险。同时，低血清白蛋白水平，以及直接抗病毒药物治疗前后甲胎蛋白高于7 ng/mL，也是肝细胞癌发生的独立预测指标。基于这些发现，我们建议将实现病毒清除的晚期肝纤维化/肝硬化丙型肝炎患者按肝细胞癌风险分为低、中、高三级，并为不同风险层级制定相应的监测策略，包括对最高风险组采用简化磁共振成像方案进行监测。
肿瘤(癌症)患者之家