Hepatocellular Carcinoma Clinical Trial
Official title:
Development of a Predictive Model of Liver Complications Emergence in Patients With Advanced Fibrosis Who Achieve Sustained Virological Response With Direct-acting Antivirals-based Therapy
Objectives: To develop and validate a predictive model, applicable to daily practice, of
liver complications emergence in hepatitis C virus (HCV)-infected patients and advanced
fibrosis, who have achieved sustained viral response (SVR) with direct-acting antivirals
(DAA)-based therapy.
Methods:
Design: Mulsite prospective multicenter cohort study. Study subjects: HCV-monoinfected and
HIV/HCV-coinfected individuals recruited from two parallel cohorts (GEHEP-MONO Cohort
clinicaltrials.gov ID: NCT02333292(HEPAVIR-DAA Cohort clinicaltrials.gov ID: NCT02057003).
These cohorts enrolled patients with HCV infection, treated with DAA-based regimens after
October 2011, at the units of infectious diseases of 18 hospitals throughout Spain. Patients
who fullfilled the following inclusion criteria are included in this study: 1) Have received
a regimen with one or more DAA; 2) Have achieved SVR 12 weeks after treatment; 3) Have an
evaluable liver stiffness (LS) of more than 9.5 kPa in the three months prior to the start of
treatment.
Follow-up: The baseline time point is the date of SVR. All participants are evaluated by a
common protocol every six months. At every visit, clinical and laboratory examination
focusing on the early detection of liver complications are carried out. LS is assessed by
vibration-controlled transient elastography, according to a standardized procedure, every 12
months. In patients with cirrhosis, liver ultrasound and plasma alpha-fetoprotein
determination are conducted for hepatocellular carcinoma screening, every six months.
Variables and data analysis: The primary outcome variable of the study will be the emergence
of liver complication (hepatic decompensation or hepatocellular carcinoma) or liver
transplant. Predictive models will be develop with clinical, analytical, and genetic
variables independently associated with the primary variable in a Cox regression for
competitive risks applied to a developmental subpopulation. The performance of the model will
be evaluated using COR curves. Sensitivity, specificity, and positive and negative predictive
values will be calculated, both in the developmental population and in a validation
population.
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