title: A risk for hepatocellular carcinoma persists long-term after sustained virologic response in patients with hepatitis C-associated liver cirrhosis.
abstract: BACKGROUND
  The long-term effect of sustained virologic response (SVR) to antiviral therapy on the risk of developing hepatocellular carcinoma (HCC), liver complications, liver-related death, and overall death in hepatitis C virus (HCV)-infected patients with liver cirrhosis is not fully known.
  
  
  METHODS
  These risks were evaluated during long-term follow-up in 351 patients with HCV-related cirrhosis. One hundred ten patients with SVR, 193 with non-SVR, and 48 who were untreated were included in a multicenter cohort that was initiated in 2001 and prospectively followed up for a mean of 5.3 (SD, 2.8) years. Complementary follow-up data from national registries were used to minimize the loss of patients during follow-up.
  
  
  RESULTS
  Six patients with SVR developed HCC at 0.04, 0.64, 2.4, 7.4, 7.4, and 7.6 years, respectively, after achieving SVR. The incidences of HCC, any liver complication, liver-related death, and overall death per 100 person-years were significantly lower in SVR time with 1.0, 0.9, 0.7, and 1.9, compared to 2.3, 3.2, 3.0, and 4.1 in non-SVR and 4.0, 4.9, 4.5, and 5.1 in untreated time. The long-term consequences did not decline significantly after >3 years versus during the first 3 years of follow-up.
  
  
  CONCLUSIONS
  The risk for HCC, liver decompensation, and death in patients with liver cirrhosis related to HCV was markedly reduced after SVR, but a long-term risk of developing HCC remains for up to 8 years. Cirrhotic patients with HCV who achieve SVR should therefore maintain long-term surveillance for HCC. Future studies aimed to better identify those with remaining long-term risk for HCC are needed.
authors.affiliation: Departments of Gastroenterology and Hepatology and Department of Infectious Diseases, Karolinska University Hospital, at Karolinska Institutet, 171 76 Stockholm, Sweden. soo.aleman@ki.se
authors.forename: Soo
authors.initials: S
authors.lastname: Aleman
authors.forename: Nogol
authors.initials: N
authors.lastname: Rahbin
authors.forename: Ola
authors.initials: O
authors.lastname: Weiland
authors.forename: Loa
authors.initials: L
authors.lastname: Davidsdottir
authors.forename: Magnus
authors.initials: M
authors.lastname: Hedenstierna
authors.forename: Nina
authors.initials: N
authors.lastname: Rose
authors.forename: Hans
authors.initials: H
authors.lastname: Verbaan
authors.forename: Per
authors.initials: P
authors.lastname: Stål
authors.forename: Tony
authors.initials: T
authors.lastname: Carlsson
authors.forename: Hans
authors.initials: H
authors.lastname: Norrgren
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: complications; hepatocellular carcinoma; liver decompensation; liver-related death; sustained virologic response