Effect of sustained virologic response on the incidence of hepatocellular carcinoma in patients with HCV cirrhosis

Abstract

Background and objectives: Evidence suggests that sustained virologic response to interferon treatment decreases incidence of hepatocellular carcinoma in patients with hepatitis C virus cirrhosis. This study was designed to compare the incidence of hepatocellular carcinoma among cirrhotic patients exposed to interferon based treatment with or without achieving a sustained virological response, in order to evaluate the role of interferon itself in the prevention hepatocellular carcinoma. Methods: A cohort of 85 patients with compensated hepatitis C cirrhosis was followed after treatment with interferon and ribavirin. Sustained virological response was defi ned as negative polymerase chain reaction assay 24 weeks after the end of treatment. Patients were followed every 6 months with ultrasound and alpha-fetoprotein. Hepatocellular carcinoma was diagnosed by the fi nding of a focal liver lesion greater than 2 cm with arterial hypervascularization on two imaging techniques and/or by liver biopsy. Results: The mean follow-up time was 32.1 ± 20 months for patients who achieved a sustained virological response and 28.2 ± 18 months among 47 patients (55%) without SVR. Hepatocellular carcinoma was diagnosed in 1 (3%) vs. 8 (17%) responders and non responders respectively (p = 0.02). Conclusion: Patients with cirrhosis due to hepatitis C virus who achieved sustained virological response had signifi cantly lower incidence of hepatocellular carcinoma when compared to those without treatment response. Interferon treatment without achieving sustained virological response does not seem to protect against hepatocellular carcinoma.

HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta‐analysis

“…Forty‐four studies [ 13–57 ] with a total 35,739 patients and 107,548 person‐years follow‐up were included (Tables 1–3). Thirty‐six studies (29,444 patients, 91,049 person‐years follow‐up) had required data for calculating HCC incidence among patients with cirrhosis (Table 2), with cirrhosis defined by histopathology ( n = 7) or a combination of histopathology, liver stiffness measurement, imaging, or clinical features of cirrhosis ( n = 29) (Table ).…”

“…Forty‐four studies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ] with a total 35,739 patients and 107,548 person‐years follow‐up were included (Tables 1 , 2 , 3 ). Thirty‐six studies (29,444 patients, 91,049 person‐years follow‐up) had required data for calculating HCC incidence among patients with cirrhosis (Table 2 ), with cirrhosis defined by histopathology ( n = 7) or a combination of histopathology, liver stiffness measurement, imaging, or clinical feat...…”

“…Cardoso, 2016 (Portugal) [18] Retrospective, single-center a 54 59 70% --Cheinquer, 2010 (Brazil) [19] Prospective, single-center 38 51 63% 0% 0% D'Ambrosio, 2011 (Italy) [20] Prospective, single-center 62 61 65% 0% 0%…”

Splenectomy prior to antiviral therapy in patients with hepatitis C virus related decompensated cirrhosis

“… 1 Improvements in antiviral drugs, such as the pegylated (PEG) form of interferon (IFN), and treatment regimens, such as the IFN-based combination therapy with ribavirin, have achieved higher rates of sustained virological response (SVR) and improved long-term prognosis. 2 , 3 However, not all chronic hepatitis C patients are amenable to the IFN-based therapies and some develop contraindications that necessitate treatment suspension, reduced dosage, or termination of therapy. 4 , 5 When the threat of unmitigated chronic hepatitis C cases was investigated in a mathematical model of the disease's natural progression, researchers predicted a dramatic increase in the number of HCV-related cirrhotic cases over the next two decades.…”

“…Investigators aiming to identify feasible and efficacious therapies for patients with HCV-related compensated and decompensated cirrhosis have observed beneficial results from IFN-α-based antiviral therapy. 3 , 4 , 7 Unfortunately, a large proportion of these patients have preexisting neutropenia, thrombocytopenia, and anemia that tend to worsen with the use of IFN and ribavirin and necessitate dose reduction or treatment discontinuation. 4 , 5 In addition, some patients present with severe baseline thrombocytopenia and leukocytopenia due to hypersplenism that preclude initiation of IFN-based therapy.…”