{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T13:17:29Z","timestamp":1789219049595,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T00:00:00Z","timestamp":1536192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Risk of hepatocellular carcinoma (HCC) in hepatitis C virus cirrhotic patients treated with direct\u2010acting antiviral agents (DAA) is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow\u2010up of 17.3\u00a0months after end of treatment (EOT), including 943 patients without history of HCC and 102 previously treated for HCC. The majority were men (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan\u2010Meier curves were performed to detect predictors of HCC in patients with and without reduction in alpha\u2010fetoprotein (AFP) during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54 of 943 (5.7%) occurrent and 41 of 102 (39%) recurrent tumours. De novo were more often unifocal (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01) and curable (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03). AFP decreased from 16.1\u00a0\u00b1\u00a036.2\u00a0mg\/dL (baseline) to 11.4\u00a0\u00b1\u00a055\u00a0mg\/dL (EOT). At univariate analysis, predictors were a previous HCC, older age, higher model for end\u2010stage liver disease, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction in AFP during treatment. Kaplan\u2010Meier curves showed lower incidence of HCC in patients showing any reduction in AFP (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001). Those with AFP &lt;6\u00a0ng\/mL had the lowest risk (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0002). At logistic regression, platelets (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.009, OR 0.99 CI: 0.99\u20101.00), previous HCC (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.000\u00a001, OR: 10.76, 95% CI: 5.89\u201019.34) and no reduction in AFP during treatment (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0005, OR: 2.98, CI: 1.60\u20105.54) were independent predictors of HCC. In conclusion, risk of HCC after DAA treatment remains substantial. It is higher among patients with previous HCC, low platelets and without reduction in AFP during treatment.<\/jats:p>","DOI":"10.1111\/jvh.12982","type":"journal-article","created":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T08:48:04Z","timestamp":1534409284000},"page":"1493-1500","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Lack of reduction in serum alpha\u2010fetoprotein during treatment with direct antiviral agents predicts hepatocellular carcinoma development in a large cohort of patients with hepatitis C virus\u2010related cirrhosis"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1689-4876","authenticated-orcid":false,"given":"Chiara","family":"Masetti","sequence":"first","affiliation":[{"name":"Liver and Transplant Unit Tor Vergata University Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Lionetti","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2010Hepatology National Institute for Infectious Diseases Spallanzani  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinella","family":"Lupo","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Gastroenterology Unit Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Siciliano","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Catholic University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Giannelli","sequence":"additional","affiliation":[{"name":"Liver Disease Unit Department of Liver Transplantation San Camillo Forlanini Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Romana","family":"Ponziani","sequence":"additional","affiliation":[{"name":"Internal Medicine, Gastroenterology and Hepatology A. Gemelli Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Teti","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Tor Vergata University Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Dell'Unto","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit University Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Francioso","sequence":"additional","affiliation":[{"name":"Liver and Transplant Unit Tor Vergata University Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Brega","sequence":"additional","affiliation":[{"name":"Liver and Transplant Unit Tor Vergata University Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzia","family":"Montalbano","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2010Hepatology National Institute for Infectious Diseases Spallanzani  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ubaldo","family":"Visco\u2010Comandini","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2010Hepatology National Institute for Infectious Diseases Spallanzani  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Taibi","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2010Hepatology National Institute for Infectious Diseases Spallanzani  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Galati","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit University Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Vespasiani Gentilucci","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit University Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Picardi","sequence":"additional","affiliation":[{"name":"Internal Medicine and Hepatology Unit University Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Andreoni","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Tor Vergata University Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Pompili","sequence":"additional","affiliation":[{"name":"Internal Medicine, Gastroenterology and Hepatology A. 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