Suppression of HCV reduces hepatoma risk
Clinical
Last Updated: 2012-11-07 17:55:27 -0400 (Reuters Health)
Earlier studies have reported similar results, but they didn't adequately
clarify the risk factors for HCC in patients who achieve a sustained virological
response (SVR) to pegylated interferon and ribavirin, the authors say --
particularly among Japanese patients.
Dr. Jun Hayashi from Kyushu University Hospital in Fukuoka, Japan, and colleagues evaluated the relationships among pretreatment clinical factors, virological response, and the development of HCC in 1,013 patients receiving the two drugs for chronic hepatitis C, in the prospective Kyushu University Liver Disease Study.
As reported online October 23 in The Journal of Hepatology, 557 patients (55.0%) achieved an SVR, 304 (30.0%) had transient virological responses (TVR), and 152 (15.0%) had no virological response (NVR).
SVR rates were significantly lower with HCV genotype 1 vs genotype 2 (43.9% vs 80.9%; p<0.001).
The five-year cumulative incidence rate of HCC was significantly higher in the NVR group (18.8%) than in either the SVR group (3.1%; p<0.001) or the TVR group (5.8%; p<0.001).
In a multivariate logistic regression analysis, patients with NVR were 3.72 times as likely as patients with SVR to develop HCC. Other significant independent predictors of HCC were age 60 or more, male gender, low platelet count, higher alpha-fetoprotein (AFP) level, and cirrhosis.
In patients without cirrhosis, the five-year cumulative incidence rates of HCC were significantly lower in the SVR (1.7%) and TVR (3.2%) groups than in the NVR group (7.6%).
The pattern was similar in cirrhotic patients: HCC rates were significantly lower in the SVR (18.9%) and TVR (20.8%) groups than in the NVR group (39.4%).
For non-cirrhotic patients under age 60, HCC rates were lower for SVR (0.9%) and TVR (1.7%) groups than for NVR patients (2.6%), but the differences did not reach statistical significance.
Among older patients, however, HCC rates were significantly lower for patients who achieved an SVR (3.5%) or TVR (4.2%) than for patients with NVR (12.4%).
Thirteen patients with an SVR (six non-cirrhotic, seven cirrhotic) developed HCC during follow-up, leading the researchers to conclude, "Because the risk of developing HCC remains even after HCV eradication, long-term screening of patients with SVR is important."
Dr. Timothy R. Morgan from VA Long Beach Healthcare System, Long Beach, California, has conducted similar studies in the U.S. He told Reuters Health, "They seem to be finding what we found: when patients are cured of their HCV infection (by treatment), then the risk of HCC decreases significantly."
"In essence, this data continues to support all existing data that achieving an SVR, especially among patients with cirrhosis, greatly reduces the probability of developing HCC," Dr. Morgan said.
Dr. Hayashi did not respond to a request for comments.
Clinical
Last Updated: 2012-11-07 17:55:27 -0400 (Reuters Health)
Dr. Jun Hayashi from Kyushu University Hospital in Fukuoka, Japan, and colleagues evaluated the relationships among pretreatment clinical factors, virological response, and the development of HCC in 1,013 patients receiving the two drugs for chronic hepatitis C, in the prospective Kyushu University Liver Disease Study.
As reported online October 23 in The Journal of Hepatology, 557 patients (55.0%) achieved an SVR, 304 (30.0%) had transient virological responses (TVR), and 152 (15.0%) had no virological response (NVR).
SVR rates were significantly lower with HCV genotype 1 vs genotype 2 (43.9% vs 80.9%; p<0.001).
The five-year cumulative incidence rate of HCC was significantly higher in the NVR group (18.8%) than in either the SVR group (3.1%; p<0.001) or the TVR group (5.8%; p<0.001).
In a multivariate logistic regression analysis, patients with NVR were 3.72 times as likely as patients with SVR to develop HCC. Other significant independent predictors of HCC were age 60 or more, male gender, low platelet count, higher alpha-fetoprotein (AFP) level, and cirrhosis.
In patients without cirrhosis, the five-year cumulative incidence rates of HCC were significantly lower in the SVR (1.7%) and TVR (3.2%) groups than in the NVR group (7.6%).
The pattern was similar in cirrhotic patients: HCC rates were significantly lower in the SVR (18.9%) and TVR (20.8%) groups than in the NVR group (39.4%).
For non-cirrhotic patients under age 60, HCC rates were lower for SVR (0.9%) and TVR (1.7%) groups than for NVR patients (2.6%), but the differences did not reach statistical significance.
Among older patients, however, HCC rates were significantly lower for patients who achieved an SVR (3.5%) or TVR (4.2%) than for patients with NVR (12.4%).
Thirteen patients with an SVR (six non-cirrhotic, seven cirrhotic) developed HCC during follow-up, leading the researchers to conclude, "Because the risk of developing HCC remains even after HCV eradication, long-term screening of patients with SVR is important."
Dr. Timothy R. Morgan from VA Long Beach Healthcare System, Long Beach, California, has conducted similar studies in the U.S. He told Reuters Health, "They seem to be finding what we found: when patients are cured of their HCV infection (by treatment), then the risk of HCC decreases significantly."
"In essence, this data continues to support all existing data that achieving an SVR, especially among patients with cirrhosis, greatly reduces the probability of developing HCC," Dr. Morgan said.
Dr. Hayashi did not respond to a request for comments.
SOURCE: http://bit.ly/Qp6iYa
J Hepatol 2012.
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