Pre-Treatment Liver Stiffness Is a Stronger Predictor of Hepatocellular Carcinoma Development Than Post-Treatment Liver Stiffness After Hepatitis C Virus Eradication.

Introduction: Liver stiffness measurement (LSM) values decrease after hepatitis C virus eradication. However, whether this reduction translates into a reduced risk of hepatocellular carcinoma (HCC) development in patients who achieve sustained virological response (SVR) remains unclear.

Methods: We retrospectively analyzed 501 patients with chronic hepatitis C who achieved SVR after direct-acting antiviral (DAA) treatment. LSM and FIB-4 levels were measured before DAA treatment and at multiple follow-up points. Time-dependent Cox proportional hazards models evaluated the association between these time-dependent markers and HCC development.

Results: LSM and FIB-4 significantly decreased after DAA treatment in 80.4% and 70.8% of patients, respectively. During a mean follow-up of 5.7 years, 28 patients developed HCC, and in 57% of them, LSM was reduced to < 10 kPa and FIB-4 to < 3.25 at HCC diagnosis. Multivariable analysis revealed higher pre-treatment LSM (adjusted hazard ratio [aHR], 8.10; 95% confidence interval [CI], 1.82-35.95) and higher pre-treatment FIB-4 (aHR, 1.29; 95% CI, 1.11-1.51) as independent predictors of HCC, while post-treatment values at any time point showed no significant association. Patients with LSM < 10 kPa at HCC diagnosis showed better liver function and less fibrosis, but more metabolic risk factors and excessive alcohol consumption than those with LSM ≥ 10 kPa.

Conclusion: Pre-treatment LSM and FIB-4 were stronger predictors of post-SVR HCC risk than post-treatment values. Patients with higher pre-treatment values remained at an increased risk of HCC development even if these values decreased after DAA treatment, emphasizing the importance of continued HCC surveillance in this group.