Development of Hepatocellular Carcinoma by Patients Aged 75-84 with Chronic Hepatitis C Treated with Direct-acting Antivirals.

BACKGROUND Direct-acting antiviral (DAA) treatment has revolutionized hepatitis C virus care. We aimed to evaluate the risk for the development of hepatocellular carcinoma (HCC) by patients aged 75-84 with chronic hepatitis C (CHC) following HCV elimination. METHODS This multicenter cohort study included 2405 consecutive CHC patients without a history of HCC who achieved HCV elimination by DAAs. Patients who developed HCC within one year of DAA initiation were excluded. Propensity score matched (PSM) analysis was used to evaluate differences in the HCC risk in patients aged 75-84 and 60-74. RESULTS The median observational period was 3.5 years. Among the patients aged 75-84 in the high FIB-4 group (≥3.25 at baseline), there was no significant difference in the annual incidence of HCC between 12 weeks after the end of treatment FIB-4≥3.25 (2.75%/year) and <3.25 groups (2.16%/year), unlike the results of those aged 60-74 (3.61 and 1.51%/year, respectively) (adjusted hazard ratio 2.20; P=0.045). In 495 matched pairs by PSM, the cumulative HCC incidence in the age 75-84/non-cirrhosis was significantly higher compared to the age 60-74/non-cirrhosis (P=0.048). CONCLUSIONS Older patients aged 75-84 remained at high risk for the development of HCC, even after HCV elimination and the improvement of FIB-4 index to <3.25.