Risk of Hepatocellular Cancer After Virological Cure with Direct Acting Antiviral Agents in Individuals with Hepatitis C
Abstract
Purpose: The overarching goal of this project is to reduce HCC-related morbidity and mortality in persons with chronic hepatitis C (CHC) who have been virologically cured by direct acting antivirals (DAAs). Aims: 1) Examine determinants of HCC in virologically cured patients and develop a risk prediction model for HCC; 2) Conduct a virtual clinical trial using a mathematical model of the natural history of HCC to evaluate benefits vs harms of HCC surveillance; 3) Develop an online HCC Simulator. Design: Using cause-specific Cox proportional hazard models for competing risks, we will identify risk factors in a retrospective cohort study of greater than 100,000 patients with DAA-induced SVR. For dynamic risk prediction of HCC, we will use the landmark Cox model. We will use a mathematical model to simulate a virtual trial comparing long-term effectiveness of no surveillance vs routine surveillance. Finally, we will develop an interactive decision support tool. Progress: The project is in final stages of completing the HCC Simulator on-line tool. Target completion date 09/30/2023. Findings: We identified a range of predictors for HCC in virologically cured patients with CHC. Risk factors for HCC were different in patients with and without cirrhosis and some also evolved during follow-up. These factors can help with risk stratification and HCC surveillance decisions inpatients with cured HCV. These findings were reported in a manuscript accepted for publication in Am J Gastroenterology. The AUCs for the models in patients with and without cirrhosis were 0.72 (95 percent CI, 0.70-0.74) and 0.68 (95 percent CI, 0.66-0.70), respectively. A Mathematical model of the natural history of HCC in DAA-cured CHC patients was developed that led the team to conclude that the burden of HCC will shift from viremic to virologically cured CHC patients, and to older populations in the next decade.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 02, 2022
- Accession Number
- AD1191124
Entities
People
- Fasiha Kanwal
- Jagpreet Chhatwal
Organizations
- Massachusetts General Hospital