| Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-analysis |
Han Ah Lee1, Mi Na Kim2,3, Hye Ah Lee4, Miyoung Choi5, Jung Hwan Yu6, Young-Joo Jin6, Hee Yeon Kim7,8, Ji Won Han8,9, Seung Up Kim2,3, Jihyun An10
, Young Eun Chon11
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1Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
3Yonsei Liver Center, Severance Hospital, Seoul, Korea
4Clinical Trial Center, Ewha Womans University Seoul Hospital, Seoul, Korea
5Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
6Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
7Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
8The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
9Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
10Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
11Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea |
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Received: April 15, 2024 Revised: August 6, 2024 Accepted: August 12, 2024
*Han Ah Lee and Mi Na Kim contributed equally to this work. |
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| ABSTRACT |
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Backgrounds/Aims
Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR.
Methods
We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies’ methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models.
Results
We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2–13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4–11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa.
Conclusions
VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact. |
| KeyWords:
Vibration-controlled transient elastography; Fibrosis 4-index; Hepatitis C virus; Hepatocellular carcinoma; Prediction |
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