Ogawa E, et al. - The short-term risk of hepatocellular carcinoma (HCC) among patients with a sustained viral response (SVR) by direct-acting anti-virals (DAAs), including those with cirrhosis or previous HCC was evaluated. For predicting de novo HCC or recurrence, serum α-fetoprotein level at the end of treatment (EOT-AFP) level and previous HCC characteristics would be useful markers for cirrhotic patients after elimination of hepatitis C virus (HCV).

• The physicians enrolled 1,675 consecutive patients who achieved SVR by treatment with interferon-free sofosbuvir-based regimens in this large-scale, multicentre cohort study.
• They divided them into groups with (n = 152) or without previous HCC (n = 1,523).
• To calculate the cumulative HCC incidence and related factors of HCC, the Kaplan-Meier method and Cox proportional hazard analysis were used.

• 46 (2.7%) patients developed HCC during the follow-up period (median: 17 months).
• For the noncirrhosis and cirrhosis groups, the 1-year cumulative rates of de novo HCC were 0.4% and 4.9%, respectively (log-rank test: P < 0.001).
• Serum EOT-AFP was the strongest predictor of de novo HCC for cirrhotic patients.
• In the EOT-AFP < 9.0 ng/mL and ≥ 9.0 ng/mL groups (cut-off value), the 1-year cumulative de novo HCC rates were 1.4% and 13.1%, respectively (log-rank test: P < 0.001).
• The 1-year cumulative rates of HCC recurrence for the noncirrhosis and cirrhosis groups were 6.5% and 23.1%, respectively (log-rank test: P = 0.023).
• Previous HCC characteristics were significantly correlated with HCC recurrence for cirrhotic patients.
• On the other hand, sex, age, and metabolic features did not affect de novo HCC or recurrence.