Predictors of Hepatocellular Carcinoma in CHB and CHC

Hepatitis B virus (HBV) is the most common cause of HCC as per the Global Burden of Disease data (2019).

The most important risk factors for HCC, as mentioned in the INASL Puri recommendations include cirrhosis liver, HBV infection, chronic hepatitis C (CHC) infection, alcohol consumption and afl atoxin exposure. Other important risk factors are diabetes, NAFLD, smoking and tobacco use. The consensus statement notes that currently there is insuffi cient data to implicate any genetic risk factor for HCC in India.

In Indian patients with HBV, HCC is more often associated with HBV genotype D/mixed genotype infection, HBV DNA (>10,000 copies/mL), persistently elevated serum ALT and high HBsAg levels.

 In Indian hepatitis C virus (HCV) patients, HCC is more often associated with HCV genotype 4 infection and high serum HCV RNA levels. Cirrhosis, low albumin, low platelets, alpha-fetoprotein (AFP) levels after treatment are indicators of high HCC occurrence even after achieving sustained virologic response (SVR).

Various HCC risk calculators can be used to assess the risk. These include CU-HCC (age, HBV DNA, albumin, total bilirubin, cirrhosis), GAG-HCC (sex, age, HBV DNA, core promoter mutations, cirrhosis), REACH-B (sex, age, HBeAg, HBV DNA, ALT) and PAGE-B (sex, age, platelets).

The HCC recurrence rate after liver transplantation is 13% overall, after resection, it is 70% in 5 years and after ablation, it is up to 85% in 5 years. The predictors of recurrence are underlying cirrhosis, morphology (size, number and extent) and biology (AFP, PIVKA).

The 5-year cumulative risk of HCC in CHC patients after SVR is 6%. The factors associated with the risk are advanced fi brosis, AFP >7, ALBI grade >2 and BMI ≥25.