Dr. Abdelaleem Helal, Menoufia University Egypt
Title: Transient Elastography as Predictor of De Novo Hepatocellular Carcinoma (HCC) Development in Cirrhotic Patients with Chronic Hepatitis C Treated With Direct Acting Antiviral Drugs (DAAs).
Abdelaleem Helal has his expertise in viral hepatitis and HCC from his Prof. Dr. Mohamed Akl and colleges in Department of Hepatology and Gastroenterology, National Liver Institute, Menofia University, Shebeen El-Kom, Egypt.
Background: Hepatocellular carcinoma is a common health burden in cirrhotic patients with HCV infection. New direct-acting antivirals substantially improved the cure rate to above 90%. Moreover, cancer risk persists even after 10 years of viral cure.
Aim: To evaluate Transient Elastography as predictor of HCC after Direct acting antiviral drugs (DAAs).
Methods: All patients with HCV related fibrosis who did FibroScanTM before treatment with DAAs were included retrospectively. Liver, renal function tests, CBC, INR, alpha-fetoprotien, abdominal ultrasonography, Triphasic CT, and FibroScanTM were performed at the National Liver Institute, Menofia University from January 2015 to December 2016. Patients who had a Transient Elastography measurement before treatment with DAAs were included and divided into two groups; Group (I) patients who developed De novo HCC and Group (II) are those who did not developed HCC after DAAs.
Results: Patients who developed de novo HCC after DAAs (group I, thirty patients) had higher serum AST levels (68.3 ± 38.2 vs. 48.7 ± 32.4 U/L), lower platelet count (131.5 ± 55.6 vs. 179.5 ± 69.8 ×103 /µL) and older age (59.5±6.4 vs. 51.3±10.5 years) than patients who did not developed HCC (group II, ninety patients) with a p value <0.05. Group I patients had a statistically significant higher liver stiffness measurement (LSM) by FibroscanTM (32.1 ± 10.7 vs 15.5± 11.5 kPa, p value = 0.001) than patients who did not developed HCC. With a cutoff of 18.5 kPa being the most predictive value of de novo HCC development after treatment of chronic HCV infection with DAAs (90.0% sensitivity, 80.0% specificity, 55.0% PPV, 97.3% NPV, 80.0% accuracy) as shown in figure 1.
Conclusion: The measurement of liver stiffness by FibroScanTM could be a reliable method for risk stratification and prediction of de novo HCC development after DAAs in cirrhotic patients.