Necessity for surveillance for hepatocellualr carcinoma in older patients with chronic hepatitis C who achieved sustained virological response

Shun Ishido; Nobuharu Tamaki; Masayuki Kurosaki; Nami Mori; Keiji Tsuji; Chitomi Hasebe; Toshie Mashiba; Hironori Ochi; Yutaka Yasui; Takehiro Akahane; Koichiro Furuta; Haruhiko Kobashi; Hideki Fujii; Toru Ishii; Hiroyuki Marusawa; Masahiko Kondo; Atsunori Kusakabe; Hideo Yoshida; Yasushi Uchida; Toshifumi Tada; Shinichiro Nakamura; Akari Mitsuda; Chikara Ogawa; Hirotaka Arai; Toshimitsu Murohisa; Minoru Uebayashi; Namiki Izumi

doi:10.1002/jgh3.12914

Necessity for surveillance for hepatocellualr carcinoma in older patients with chronic hepatitis C who achieved sustained virological response

JGH Open. 2023 May 29;7(6):424-430. doi: 10.1002/jgh3.12914. eCollection 2023 Jun.

Authors

Shun Ishido¹, Nobuharu Tamaki¹, Masayuki Kurosaki¹, Nami Mori², Keiji Tsuji², Chitomi Hasebe³, Toshie Mashiba⁴, Hironori Ochi⁴, Yutaka Yasui¹, Takehiro Akahane⁵, Koichiro Furuta⁶, Haruhiko Kobashi⁷, Hideki Fujii⁸, Toru Ishii⁹, Hiroyuki Marusawa¹⁰, Masahiko Kondo¹¹, Atsunori Kusakabe¹², Hideo Yoshida¹³, Yasushi Uchida¹⁴, Toshifumi Tada¹⁵, Shinichiro Nakamura¹⁵, Akari Mitsuda¹⁶, Chikara Ogawa¹⁷, Hirotaka Arai¹⁸, Toshimitsu Murohisa¹⁹, Minoru Uebayashi²⁰, Namiki Izumi¹

Affiliations

¹ Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan.
² Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic Bomb Survivors' Hospital Hiroshima Japan.
³ Department of Gastroenterology Asahikawa Red Cross Hospital Asahikawa Japan.
⁴ Center for Liver-Biliary-Pancreatic Disease Matsuyama Red Cross Hospital Matsuyama Japan.
⁵ Department of Gastroenterology Ishinomaki Red Cross Hospital Ishinomaki Japan.
⁶ Department of Gastroenterology Masuda Red Cross Hospital Masuda Japan.
⁷ Department of Gastroenterology Japanese Red Cross Okayama Hospital Okayama Japan.
⁸ Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Kyoto Japan.
⁹ Department of Gastroenterology Japanese Red Cross Akita Hospital Akita Japan.
¹⁰ Department of Gastroenterology and Hepatology Osaka Red Cross Hospital Osaka Japan.
¹¹ Department of Gastroenterology Otsu Red Cross Hospital Otsu Japan.
¹² Department of Gastroenterology Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Nagoya Japan.
¹³ Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan.
¹⁴ Department of Gastroenterology Matsue Red Cross Hospital Matsue Japan.
¹⁵ Department of Internal Medicine Himeji Red Cross Hospital Himeji Japan.
¹⁶ Department of Gastroenterology Tottori Red Cross Hospital Tottori Japan.
¹⁷ Department of Gastroenterology Takamatsu Red Cross Hospital Takamatsu Japan.
¹⁸ Department of Gastroenterology Maebashi Red Cross Hospital Maebashi Japan.
¹⁹ Department of Gastroenterology Japanese Red Cross Ashikaga Hospital Ashikaga Japan.
²⁰ Department of Gastroenterology Kitami Red Cross Hospital Kitami Japan.

Abstract

Background and aim: Hepatocellular carcinoma (HCC) surveillance in low-risk patients (annual incidence <1.5%) is not recommended per the American Association for the Study of Liver Diseases guidelines. Because patients with chronic hepatitis C with non-advanced fibrosis who have achieved sustained virological response (SVR) have a low risk of HCC, HCC surveillance is not recommended for them. However, aging is a risk factor for HCC; threfore, the necessity for HCC surveillance in older patients with non-advanced fibrosis needs to be verified.

Methods: This multicenter, prospective study enrolled 4993 patients with SVR (1998 patients with advanced fibrosis and 2995 patients with non-advanced fibrosis). The HCC incidence was examined with particular attention to age.

Results: The 3-year incidence of HCC in patients with advanced and non-advanced fibrosis was 9.2% (95% CI: 7.8-10.9) and 2.9% (95% CI: 2.1-3.7), respectively. HCC incidence was significantly higher in patients with advanced fibrosis (P < 0.001). HCC incidence stratified by age and sex was investigated in patients with non-advanced fibrosis. The HCC incidence in the 18-49, 50s, 60s, 70s, and ≥80 age groups were 0.26, 1.3, 1.8, 1.7, and 2.9 per 100 person-years in men, and 0.00, 0.32, 0.58, 0.49, and 0.57 per 100 person-years in women, respectively.

Conclusions: Male patients with non-advanced fibrosis aged ≥60 years have a higher risk of developing HCC and, thus, require HCC surveillance.

Keywords: chronic hepatitis C; hepatocellular carcinoma; surveillance; sustained virological response.