Madhumita Premkumar, Prerna Sharma, Pankaj Gupta, Anchal Sandhu, Harish Bhujade, Radhika Srinivasan, Arka De, Nipun Verma, Ajay Duseja, Sreedhara B Chaluvashetty, Naveen Kalra, Divya Khosla, Rakesh Kapoor, Prateek Bhatia, Mini P Singh, Ekta Gupta, Jasvinder Nain, Suvradeep Mitra, Arnab Pal, Radha K Dhiman, K Rajender Reddy
DAAs achieved an SVR-12 rate exceeding 95% in genotype-3 predominant HCV-compensated cirrhosis, with and without HCC. Incidence of de novo HCC post SVR-12 was 985 per 100,000 person-years, and 60% had BCLC Stage A. Post-SVR LSM and ALBI score predicted risk of HCC. Our data argue for mandatory HCC surveillance under the NVHCP for all patients with HCV-cirrhosis in India.
BACKGROUND: Genotype-3 HCV cirrhosis is a major risk for hepatocellular carcinoma (HCC). We assessed DAA treatment-related SVR rates, and HCC characteristics and outcomes in a prospective, predominantly genotype-3 compensated cirrhosis cohort participating in the National Viral Hepatitis Control Programme (NVHCP) for HCV elimination in India.
METHODS: Viremic HCV-related HCC diagnosed at presentation and within 6 months (pre-DAAs), and those with post-SVR-12 HCC (post-DAAs) between 15 October 2018 and 31 December 2024, were evaluated.
RESULTS: Among 51,865 HCV patients, 4646 had compensated cirrhosis, 652 had HCC, of whom 399 were treated at the hub. 368/399 (92.2%) at presentation had viremic HCV-cirrhosis related HCC (aged 61.5 ± 10.5 years, 65.2% men, 77.8% genotype-3, median ALBI -2.0, with presentation in BCLC stages A (26.1%), B (25.3%), C (12.8%), and D (35.9%), 16% had portal vein thrombosis while 31 (7.8%) did not have cirrhosis. Ultimate SVR-12 after one or more DAAs courses was in 360/368 (97.8%) in HCV-cirrhosis with HCC(at presentation) and in 3874/3994 (96.9%; P = 0.366) with HCV-cirrhosis without HCC. De novo HCC post SVR-12 was in 128/3994 (3.2%), median follow-up of 4 years, an incidence of 985 per 100,000 person-years; aged 57.6 ± 8.6 years, 77.3% men, 71.6% genotype-3, BCLC stages were A (60.2%), B (28.9%), and C (10.9%). Liver stiffness at SVR-48 (aHR 1.01, 95% CI: 1.001-1.030, P = 0.021) and ALBI score at SVR-12 (aHR 1.31, 95% CI: 1.1-1.4, P = 0.034) independently predicted de novo HCC. The recurrence rate was lower in patients with de novo HCC than in those with HCC at presentation (2.2 vs 17.6 per 100 person-years). 27 (21.1%) died, 4 (3.1%) underwent transplantation.
CONCLUSION: DAAs achieved an SVR-12 rate exceeding 95% in genotype-3 predominant HCV-compensated cirrhosis, with and without HCC. Incidence of de novo HCC post SVR-12 was 985 per 100,000 person-years, and 60% had BCLC Stage A. Post-SVR LSM and ALBI score predicted risk of HCC. Our data argue for mandatory HCC surveillance under the NVHCP for all patients with HCV-cirrhosis in India.