Baseline gamma-glutamyl transferase levels strongly correlate with hepatocellular carcinoma development in non-cirrhotic patients with successful hepatitis C virus eradication

Background & Aims: Hepatitis C virus (HCV)-infected patients with cirrhosis remain at risk of hepatocellular carcinoma (HCC) even after achieving sustained virological response (SVR). The aim of the study was to explore the incidence and risk for HCC among non-cirrhotic patients with an SVR. Methods: A total of 642 patients with an SVR after peginterferon/ribavirin therapy were enrolled with a median follow-up period of 53.0 months (range: 6-133 months). Results: Thirty-three of the 642 (5.1%) patients developed HCC over 2324.8 person-years of follow-up. Cox regression analysis revealed that the strongest predictive factor of HCC occurrence was liver cirrhosis (HR 4.98, 95% CI 2.32-10.71, p <0.001), followed by age (HR 1.06, 95% CI 1.02-1.11, p = 0.005) and gamma GT levels (HR 1.008, 95% Cl 1.004-1.013, p <0.001). The incidence of HCC did not differ between patients with high and low baseline gamma GT levels among patients with cirrhosis (p = 0.53), but the incidence of HCC was significantly higher in non-cirrhotic patients with high gamma GT levels compared with those with low gamma GT levels (p = 0.001). Cox regression analysis revealed that the strongest factors associated with HCC development in non-cirrhotic sustained responders were baseline gamma GT levels (HR 6.44, 95% Cl 2.20-18.89, p = 0.001) and age (HR 3.68, 95% CI 1.33-10.17, p = 0.012). The incidence of HCC was not different between older non-cirrhotic patients with high gamma GT levels and cirrhotic patients (p = 0.34). Conclusions: HCC remains a threat in non-cirrhotic patients with an SVR. Serum gamma GT levels helped to identify potential patients at high risk. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.