Development of models estimating the risk of hepatocellular carcinoma after antiviral treatment for hepatitis C

Ioannou, George N.; Green, Pamela K.; Beste, Lauren A.; Mun, Elijah J.; Kerr, Kathleen F.; Berry, Kristin

doi:10.1016/j.jhep.2018.07.024

Cited by 128 publications

(138 citation statements)

References 46 publications

(45 reference statements)

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“…We studied all liver cancers with known treatment outcomes and found that the presence of a ‘lesion’ on previous scans, diabetes and thrombocytopaenia was associated with subsequent development of malignancy. These findings are consistent with previous studies but will require formal confirmation in a larger cohort. At present, we would recommend more intensive HCC surveillance in patients with these characteristics to allow early identification of lesions at a stage where they may be amenable to therapy.…”

Section: Discussionsupporting

confidence: 92%

The association between hepatocellular carcinoma and direct‐acting anti‐viral treatment in patients with decompensated cirrhosis

Mecci

Kemos

Leen

et al. 2019

Aliment Pharmacol Ther

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Background: Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. Aim: To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. Methods: All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. Results: Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165(87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. Conclusion:There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate. | 205MECCI Et al.

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Section: Discussionsupporting

confidence: 92%

The association between hepatocellular carcinoma and direct‐acting anti‐viral treatment in patients with decompensated cirrhosis

Mecci

Kemos

Leen

et al. 2019

Aliment Pharmacol Ther

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“…[46][47][48][49][50] The developed prediction model for HCC has also been created to guide follow-up strategies. 51,52 It is noteworthy that the risk of HCC persists even after 10 years of viral eradication. 53 It has been suggested that HCV-induced oncogenic effects are elicited before treatment and that the "epigenetic scar" may leave and persist long after viral eradication, leading to a lifelong risk of HCC.…”

Section: Hccmentioning

confidence: 99%

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

Huang

2020

Clin Mol Hepatol

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The treatment of chronic hepatitis C (CHC) has been revolutionized in an era of all-oral direct-acting antivirals (DAAs) since 2014. Satisfactory treatment efficacy and tolerability can be provided by novel DAAs. Nevertheless, there are still some unmet needs and emerging issues in the treatment of CHC in the DAA era. Certain hard-to-cure populations are prone to have inferior treatment responses, including patients with severe liver decompensation, active hepatocellular carcinoma (HCC), and hepatitis C virus (HCV) genotype 3 (HCV-3) infection and those who experience multiple DAA treatment failures. Hepatitis B virus (HBV) reactivation during and after DAA treatment has raised concern regarding the use of prophylactic antivirals against HBV throughout DAA treatment. However, the standard strategy for the use of prophylactic antivirals is not uniform across regional guidelines. In the post-sustained virological response (SVR) period, HCC still occurs in a substantial proportion of patients. Due to the relatively short follow-up period, the net benefit of the achievement of an SVR by DAAs in the reduction of extrahepatic manifestations has not yet been determined. Attention must also be paid to HCV reinfection, particularly in high-risk populations. The most critical and unmet need for HCV elimination is the large gap in the HCV care cascade at the population level. To accomplish the World Health Organization (WHO)’s goal for HCV elimination by 2030, the expansion of access to HCV care requires a continuous effort to overcome practical and political challenges.

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“…2B), persistent circulating necroinflammatory markers or impaired liver function despite SVR. 14,30,49 It is tempting to speculate that adapting screening strategies to the stratification of patients in groups at a low or high risk of HCC following SVR might optimise both cost-effectiveness and the allocation of limited medical resources. 50 = following SVR resulting from treatment with interferon-and DAA-based regimens.…”

Section: Identification Of Cirrhotic Patients With a Higher Residual mentioning

confidence: 99%

Management of patients with pre-therapeutic advanced liver fibrosis following HCV eradication

Nahon

Ganne-Carrié

2019

JHEP Reports

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Patients with HCV-related bridging fibrosis or cirrhosis remain at risk of developing lifethreatening complications even after achieving a sustained virological response. Although it is reduced, the risk of liver-related events in these patients justifies their inclusion in surveillance programmes dedicated to the early detection of hepatocellular carcinoma and the screening for portal hypertension. Biochemical parameters or non-invasive tests might indicate the potential progression of liver injury despite viral clearance. Specific attention must be focused on the management of comorbidities, while dedicated educational programmes must be encouraged to increase compliance and commitment to surveillance. Better knowledge of the long-term evolution of these patients, who now live longer, is essential to improve risk stratification and refine screening strategies in this growing population.

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Development of models estimating the risk of hepatocellular carcinoma after antiviral treatment for hepatitis C

Cited by 128 publications

References 46 publications

The association between hepatocellular carcinoma and direct‐acting anti‐viral treatment in patients with decompensated cirrhosis

The association between hepatocellular carcinoma and direct‐acting anti‐viral treatment in patients with decompensated cirrhosis

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

Management of patients with pre-therapeutic advanced liver fibrosis following HCV eradication

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