HCC development and surveillance after SVR

Anti-viral treatment for hepatitis C virus (HCV) has dramatically improved by the development of direct-acting antiviral agents (DAAs). Although a sustained virologic response (SVR) rate has become approximately 100% with DAAs, the ultimate goal of treatment for HCV is not to achieve SVR itself, but to suppress hepatocarcinogenesis and liver-related mortality elicited by continuous infection of HCV. Along with DAAs developments, incidence of hepatocellular carcinoma (HCC) has been decreased. However, HCC still develop after eradication of HCV with incidence ranges from 2.3% to 8.8% at 5 years after SVR and from 3.1% to 11.1% at 10 years after SVR. In this regard, it is a very important to identify risk factors for HCC development after SVR, and to develop more effective surveillance strategy for HCC. Even after achieving SVR, periodic screening for HCC should be continued based on the currently known identified risk factors such as age, male sex, fibrosis progression, alcohol intake, hepatic steatosis, and diabetes as well as post-treatment biomarkers. Analyses of our prospective databases of chronic hepatitis C patients who were treated with DAAs identified AFP and WFA⁺ Mac-2 binding protein (M2BPGi) as the biomarkers for assessing the risk of HCC occurrence and recurrence after SVR, and demonstrated these constitute a helpful screening biomarker for enclosure of the risk patients. In future, it is required to explore the mechanism of carcinogenesis after SVR, to develop more precise biomarkers predicting carcinogenesis after SVR, and to undertake new measures based on these findings. Advancement of both basic and clinical research in this field is strongly anticipated.