Clinical implications of fibrosis marker dynamics after hepatitis C cure: Insights from paired biopsies

PURPOSE: Studies exploring changes in fibrosis markers and their predictive performance for histological fibrosis staging after hepatitis C virus (HCV) eradication are limited. The aim of this study was to examine the predictive performance of and exclusionary and confirmatory thresholds for the ELF test, FIB-4 index, APRI, M2BPGi, liver stiffness measurement (LSM) through acoustic radiation force impulse elastography, and the collagen proportionate area (CPA) for each METAVIR fibrosis stage after treatment. METHODS: We examined 280 and 207 patients (3.1 ± 0.3 years) before and after HCV eradication, respectively, of whom 197 underwent paired liver biopsies. Statistical analysis assessed fibrosis markers' predictive performance using AUROC and ROC curves, and their optimal thresholds. RESULTS: The median ELF, FIB-4, APRI, M2BPGi, LSM, and CPA values for each METAVIR stage and the exclusionary and confirmatory thresholds for dichotomized METAVIR stages decreased after HCV eradication. The areas under the receiver operating characteristic curve (AUROCs) derived for ELF, FIB-4, APRI, M2BPGi, LSM, and CPA for predicting advanced fibrosis (F3-F4) were 0.803, 0.826, 0.784, 0.750, 0.863, and 0.920, respectively, before viral eradication and 0.710, 0.791, 0.766, 0.699, 0.810, and 0.901, respectively, after viral eradication. CPA had the highest AUROCs for predicting significant (F2-F4) and advanced fibrosis (F3-F4) before and after HCV eradication. Most of the fibrosis markers decreased significantly after viral eradication, regardless of METAVIR fibrosis stage changes. CONCLUSIONS: Noninvasive fibrosis markers can be used at a low threshold to determine the stage of liver fibrosis, although their predictive performance decreases after HCV eradication.