Metabolic and liver stiffness measures for hepatocellular carcinoma risk stratification after viral eradication in chronic hepatitis C.

[BACKGROUND/PURPOSE] To evaluate the combined utility of the aggregate metabolic factors and liver disease measures in predicting hepatocellular carcinoma (HCC) risk after achieving sustained virological response (SVR) in patients with chronic hepatitis C (CHC).

[METHODS] A retrospective cohort study of 811 patients with CHC between 2016 and 2025 was conducted. Metabolic factors were summed to derive the metabolic factor sum (MFS). Cox regression analysis assessed the combined predictive value of the MFS and clinical liver measures.

[RESULTS] During a median follow-up of 31.1 months, 36 patients developed HCC. An integrated risk score was developed based on independent predictors, including MFS, liver stiffness (LS), alpha-fetoprotein, and platelet count. The score demonstrated a concordance index of 0.861 and a 36-month area under the curve of 0.879. A discrete low-risk benchmark (LS < 1.50 m/s and MFS <3) identified a subgroup (n = 323) with no HCC development, potentially reducing the surveillance burden by 39.8%. An all-predictor low-risk benchmark (n = 215) also yielded zero HCC cases but at a higher surveillance burden of 73.5%. In contrast, the weighted integrated risk score optimized this balance, identifying a low-risk subgroup (n = 405) with an HCC incidence of only 0.2% and a reduced surveillance burden of 50.1%.

[CONCLUSION] This post-treatment stratification strategy effectively identifies patient subgroups with a low observed risk of HCC. The integrated risk score provides a superior balance between minimizing missed HCC cases and reducing the burden of unnecessary surveillance procedures compared to discrete clinical benchmarks.