Risk factors of hepatocellular carcinoma development in non‐cirrhotic patients with sustained virologic response for chronic hepatitis C virus infection

Abstract Background and Aim Hepatocellular carcinoma ( HCC ) can develop in patients with chronic hepatitis C after they have achieved a sustained virologic response ( SVR ) to antiviral therapy, that is eradication of hepatitis C virus ( HCV ). Thus, surveillance for HCC remains necessary after SVR . We investigated factors that are predictive of HCC in HCV ‐infected patients who achieved SVR . Methods The incidence and risk factors for HCC were evaluated in 522 patients who achieved SVR with interferon‐based antiviral therapy for HCV . Patients maintained regular follow‐up every 6 months for HCC surveillance. The F IB ‐4 index and aspartate aminotransferase to platelet count ratio index were calculated based on laboratory data at the time that SVR was documented ( SVR 24). Results Patients continued follow‐up visits for 1.0–22.9 years (median, 7.2 years) after SVR . HCC developed in 18 patients. The incidence of HCC was 1.2% at 5 years and 4.3% at 10 years. The use of peginterferon or ribavirin for treatment and a history of antiviral therapy prior to the course when SVR was achieved were not associated with the incidence of HCC after SVR . The presence of diabetes mellitus (risk ratio 2.08; P = 0.0451) and FIB ‐4 index calculated at the time of SVR24 (risk ratio 1.73; P = 0.0198) were associated with a higher likelihood of HCC after SVR by multivariate analysis. Conclusions Patients with diabetes mellitus and patients with the elevation of FIB ‐4 index at SVR 24 are at higher risk of HCC after SVR . Surveillance for HCC should be continued in this patient subpopulation.