Utilidad de los marcadores no invasivos de fibrosis hepática en la predicción de hepatocarcinoma tras la respuesta viral sostenida en pacientes con fibrosis avanzada y cirrosis compensada por el virus de la hepatitis C

Résumé

Hepatitis C virus (HCV) chronic infection is a leading cause of liver related morbidity and mortality worldwide. After sustained virological response (SVR) the risk of developing hepatocellular carcinoma is not completely eliminated in patients with established cirrhosis or advanced fibrosis, so lifelong surveillance is recommended. The simulation model projected that the annual incidence of HCC among patients with virologically cured HCV will continue increasing to 2031 because universal screening and microelimination strategies. Considering that many of the new diagnoses of HCV infection are made in patients with advanced fibrosis or liver cirrhosis, the number of candidates for HCC surveillance in the population with sustained virological response is projected to increase to more than 60% in the proportion of patients who undergo HCC screening strategies after SVR. A cancer surveillance program should be cost-effective, even more, when it is lifelong required. HCC surveillance is considered cost-effective inpatients with established cirrhosis in whom annual incidence is higher than 1,5%. However, HCC screening in all patients with advanced fibrosis (F3) after SVR iscontroversial and scientific societies need more evidence to maintain or rejectcurrent recommendations. Since the risk of HCC is variable among these patients, the challenge is identifying those at high-risk for developing HCC during follow up. The purpose of this study is to determine the ability of non-invasive liver fibrosismarkers and other baseline and dynamic clinical factor in predicting HCC after SVR in patients with advanced fibrosis to identify those at high risk of HCC who shouldcontinue to undergo surveillance...