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Direct-acting antivirals in hepatitis C do not reduce hepatocellular carcinoma occurrence
Patients with HCV-related cirrhosis treated with direct-acting antivirals (DAA) do not have reduced rates of hepatocellular carcinoma (HCC), according to research published in the Journal of Hepatology.
Fabio Conti, MD, PhD student, Research Center for the Study of Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Italy, and colleagues analyzed 344 cirrhotic patients without HCC who had been treated with DAA; of these patients, 59 had previous HCC. Patients were followed for 24 weeks.
During the 24-week follow-up, 26 patients had HCC; 17 of 59 patients had previous HCC, and 9 of 285 patients did not. Among the 59 patients with previous HCC, younger age and severe liver fibrosis were significantly associated with HCC recurrence.
“Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development,” said Dr Conti. “In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce the occurrence of HCC, and patients previously treated for HCC still have a high risk of tumor recurrence in the short term.”
Reference
Conti F, Buonfiglioli F, Scuteri A, et al. Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct acting antivirals. J Hepatol. 2016; pii:S0168-8278(16)30303-8; doi: 10.1016/j.jhep.2016.06.015. Epub ahead of print.
Journal of Hepatology
Patients with HCV-related cirrhosis treated with direct-acting antivirals (DAA) do not have reduced rates of hepatocellular carcinoma (HCC), according to research published in the Journal of Hepatology.
Fabio Conti, MD, PhD student, Research Center for the Study of Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Italy, and colleagues analyzed 344 cirrhotic patients without HCC who had been treated with DAA; of these patients, 59 had previous HCC. Patients were followed for 24 weeks.
During the 24-week follow-up, 26 patients had HCC; 17 of 59 patients had previous HCC, and 9 of 285 patients did not. Among the 59 patients with previous HCC, younger age and severe liver fibrosis were significantly associated with HCC recurrence.
“Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development,” said Dr Conti. “In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce the occurrence of HCC, and patients previously treated for HCC still have a high risk of tumor recurrence in the short term.”
Reference
Conti F, Buonfiglioli F, Scuteri A, et al. Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct acting antivirals. J Hepatol. 2016; pii:S0168-8278(16)30303-8; doi: 10.1016/j.jhep.2016.06.015. Epub ahead of print.
Journal of Hepatology
Abstract
Background & Aims
Hepatocellular carcinoma (HCC) represents a serious complication of HCV-related cirrhosis. New direct-acting antivirals (DAA) cure HCV infection in over 90% of patients. Aim of this study was to evaluate the early occurrence and recurrence of HCC in cirrhotic patients treated with DAA.
Methods
We analysed 344 consecutive cirrhotic patients, without HCC, who were treated with DAA, and followed for 24 weeks. Fifty-nine patients had previous HCC.
Results
DAA therapy induced sustained virological response in 91% of patients. During 24-week follow-up, HCC was detected in 26 patients (7.6%, 95% CI: 4.99-10.84): 17 of 59 patients (28.81%, 95% CI: 17.76-42.07) with previous HCC and 9 of 285 patients (3.16%, 95% CI: 1.45-5.90) without previous HCC. Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development, at univariate analysis. At multivariate analysis, Child Pugh class (p= 0.03, OR: 4.18, 95% CI: 1.17-14.8) and history of HCC (p< 0.0001, OR: 12.0, 95% CI: 4.02-35.74) resulted independently associated with HCC development. Among the 59 patients with previous HCC, younger age and more severe liver fibrosis were significantly associated with HCC recurrence, both at univariate and at multivariate analysis.
Background & Aims
Hepatocellular carcinoma (HCC) represents a serious complication of HCV-related cirrhosis. New direct-acting antivirals (DAA) cure HCV infection in over 90% of patients. Aim of this study was to evaluate the early occurrence and recurrence of HCC in cirrhotic patients treated with DAA.
Methods
We analysed 344 consecutive cirrhotic patients, without HCC, who were treated with DAA, and followed for 24 weeks. Fifty-nine patients had previous HCC.
Results
DAA therapy induced sustained virological response in 91% of patients. During 24-week follow-up, HCC was detected in 26 patients (7.6%, 95% CI: 4.99-10.84): 17 of 59 patients (28.81%, 95% CI: 17.76-42.07) with previous HCC and 9 of 285 patients (3.16%, 95% CI: 1.45-5.90) without previous HCC. Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development, at univariate analysis. At multivariate analysis, Child Pugh class (p= 0.03, OR: 4.18, 95% CI: 1.17-14.8) and history of HCC (p< 0.0001, OR: 12.0, 95% CI: 4.02-35.74) resulted independently associated with HCC development. Among the 59 patients with previous HCC, younger age and more severe liver fibrosis were significantly associated with HCC recurrence, both at univariate and at multivariate analysis.
Conclusions
In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce occurrence of HCC, and patients previously treated for HCC have still a high risk of tumour recurrence, in the short term. For these reasons, all cirrhotic patients should be closely monitored and followed during and after antiviral therapy.
Lay Summary
New direct-acting antivirals are able to eradicate HCV infection in over 90% of patients with advanced liver disease. Unfortunately, the occurrence of liver cancer is not reduced in effectively treated cirrhotic patients. In addition, patients previously treated for HCC have still a high risk of tumour recurrence in the short term, despite DAA treatment.
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