Association between steatohepatitis biomarkers and hepatocellular carcinoma after hepatitis C elimination

<jats:title>Summary</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>A strong association between chronic hepatitis C (CHC) and hepatic steatosis has been reported. However, the influence of steatohepatitis on hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) elimination remains unclear.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To evaluate the development of HCC after HCV cure using a new steatohepatitis‐related biomarker.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This cohort study analysed the prospective database of 290 CHC patients without a history of HCC who achieved HCV elimination by direct‐acting antivirals. We calculated the FibroScan‐aspartate aminotransferase (FAST) score 12 weeks after the end of treatment (pw12). The risk of HCC was analysed using the multivariable Cox proportional hazard model.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>HCV genotype (GT)1 was most prevalent at 72.4%, followed by GT2 (26.6%). Median follow‐up period was 4.2 years (IQR 3.1‐4.5). The cumulative HCC incidence for a FAST score ≥ 0.35 was significantly higher than that for a FAST score < 0.35 (log‐rank test: <jats:italic>P</jats:italic> < 0.001). The annual HCC incidence rate for a FAST score ≥ 0.35 was significantly higher than that for a FAST score < 0.35, in patients with liver stiffness measurement (LSM) ≥10 kPa (adjusted hazard ratio [HR] 4.41, 95% confidence interval [CI] 1.30‐15.0, <jats:italic>P</jats:italic> = 0.018). After adjusting for variables, including age, albumin, alpha‐fetoprotein, the patatin‐like phospholipase domain‐containing the 3 (PNPLA3) rs738409 genotype, and pw12 fibrosis markers with FIB‐4, non‐alcoholic fatty liver disease fibrosis score, and LSM, FAST score ≥ 0.35 was associated with the development of HCC (adjusted HR 4.42, 95% CI 1.02‐19.9, <jats:italic>P</jats:italic> = 0.043).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Steatohepatitis‐related biomarkers with the FAST score are helpful for predicting the development of HCC after HCV elimination.</jats:p></jats:sec>