Liver Stiffness Measurements After Oral Antivirals Effectively Predict the Risk of HCC in Patients With Chronic Hepatitis C

Hepatocellular carcinoma (HCC) can still occur in patients with chronic hepatitis C after achieving a sustained virologic response (SVR) with direct-acting antiviral (DAA) therapy. Therefore, we aimed to identify and validate predictors and HCC risk models using longitudinal data. This retrospective cohort study included patients who achieved SVR after DAA therapy. Model performance was assessed using Harrell's C-index and the area under the time-dependent receiver operating characteristic curve (AUROC). After excluding patients who developed HCC or died within 1 year after achieving SVR, a total of 2778 patients were finally included in this study. 154 (5.5%) patients developed HCC at a median of 3.3 years. LSM value showed significant improvement after antiviral therapy (all p < 0.05). In the multivariable analysis, LSM at baseline and 1 year after SVR were significantly associated with the occurrence of HCC (all p < 0.05). LSM at 1 year after SVR could better predict HCC risk than baseline LSM (C-index: 0.760, 0.788 at baseline, 1 year after SVR, respectively). Low-risk patients (LSM < 10 kPa) using LSM values at 1 year after SVR (76.4%) showed an incidence risk of 0.482 incidence rate/100 patient-years. In patients with advanced chronic liver disease, LSM at 1 year after SVR demonstrated superior predictive performance for HCC development compared to baseline LSM and other prediction models assessed at various time points (C-index: 0.744, 95% CI: 0.660-0.829; 3-year follow-up AUROC: 0.794, 95% CI: 0.754-0.831). LSM after achieving SVR effectively predicts HCC risk, especially in patients with advanced chronic liver disease.