Predictive scores for hepatocellular carcinoma occurrence after hepatitis c virus cure with direct antivirals

Hepatitis C virus (HCV) chronic infection has an important tumorigenic propensity and represents a major cause of hepatocellular carcinoma (HCC). Although the therapy of chronic HCV infection has been revolutionized with the introduction of direct acting antivirals (DAAs) resulting in sustained virological response (SVR) in up to 98% of patients, viral clearance does not totally alleviate the risk of liver-related complications, including HCC. The aim of our study was to assess the performance of predictive scores for HCC occurrence in patients with chronic HCV infection who obtained SVR with DAAs. Material and methods: We conducted a prospective study in which we included 992 patients diagnosed with chronic HCV infection and treated with DAAs, between 1st November 2015 and 31st December 2020. HCC risk scoring systems were applied to each patient enrolled in the study before starting DAA treatment. HCC was diagnosed by imaging methods such as computed tomography and magnetic resonance imaging. Results: Of the 992 patients included in the study, 59 (5.9%) were diagnosed with HCC during the follow-up period, mostly women (55.9%) with a mean age of 60-69 years. The mean time to HCC onset was 19.53 +/- 11.553 months, with a median of 17 months, with a cumulative incidence at 1, 3, and 5 years of 1.1%, 2.1%, and 2.9%, respectively. The General Evaluation Score (GES), aMAP and ADRESS score had statistically significant higher values in patients with HCC than in those without HCC. GES demonstrated a good discriminating power with an AUC coefficient of 0.804 at a cut-off value of 6.25 which has good sensitivity and specificity (0.746 and 0.799, respectively). Conclusions: GES score has a very good predictive power for the risk of HCC after obtaining SVR and could be recommended in clinical practice. Future development and validation of other individualized predictive scores score is needed for a correct and cost-efficient selection of patients with high risk of HCC.