Progression of chronic liver disease to hepatocellular carcinoma: implications for surveillance and management

Johnson, Philip J ORCID: 0000-0003-1404-0209, Kalyuzhnyy, Anton, Boswell, Ellen and Toyoda, Hidenori (2024) Progression of chronic liver disease to hepatocellular carcinoma: implications for surveillance and management. BJC Reports, 2 (1). 39-.

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Abstract

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Current opinion holds that hepatocellular carcinoma (HCC) arises as a stepwise progression from chronic liver disease (CLD) to cirrhosis and then to HCC. However, some HCCs may develop in a non-cirrhotic liver, raising uncertainty about their origin.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We analysed a prospectively accrued cohort of 2592 CLD patients (median follow-up = 13 years) with no prior evidence of liver cirrhosis. To track the progression of liver fibrosis prior to HCC diagnosis, we examined serial measurements of Fib-4 (an index of liver fibrosis). We also evaluated fibrosis progression in response to antiviral treatment in patients with hepatitis C (HCV) and hepatitis B (HBV). Recognising the limitations of serologic fibrosis assessment, we correlated Fib-4 and fibrosis histology within this cohort.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among HCC patients, 28% had no indication of cirrhosis prior to HCC diagnosis. Only 31% of HBV-related HCC cases followed the cirrhotic pathway. HCV patients who achieved sustained virological response (SVR) developed cirrhosis approximately 7 years before HCC diagnosis.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our analysis challenges the notion of cirrhosis as an obligatory stage of HCC development in CLD patients. We affirm HBV’s direct oncogenic potential and find that achieving SVR does not universally prevent HCC development. Our findings have major implications for HCC surveillance.</jats:p> </jats:sec>

Item Type:	Article
Uncontrolled Keywords:	Clinical Research, Hepatitis, Digestive Diseases, Liver Disease, Hepatitis - B, Cancer, Rare Diseases, Emerging Infectious Diseases, Liver Cancer, Chronic Liver Disease and Cirrhosis, Hepatitis - C, Infectious Diseases, 4.2 Evaluation of markers and technologies, 4 Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Oral and gastrointestinal, 3 Good Health and Well Being
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	22 Mar 2024 09:49
Last Modified:	13 May 2024 11:13
DOI:	10.1038/s44276-024-00050-0
Related URLs:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179710