Eradication of hepatitis C virus preserve liver function and prolong survival in advanced hepatocellular carcinoma patients with limited life expectancy

Yeh, Ming‐Lun; Kuo, Hsing‐Tao; Huang, Ching‐I; Huang, Chung‐Feng; Hsieh, Ming‐Yen; Liang, Po‐Cheng; Lin, I-Hung; Hsieh, Meng‐Hsuan; Lin, Zu‐Yau; Chen, Shinn‐Chern; Dai, Chia‐Yen; Huang, Jee‐Fu; Yu, Ming‐Lung; Chuang, Wan‐Long

doi:10.1002/kjm2.12303

Cited by 10 publications

(7 citation statements)

References 39 publications

(31 reference statements)

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“…As previously noted, prior studies focused on the effect of anti-HCV therapy after HCC developed and have shown improved liver-related and overall survival [ 11 , 17 , 22 , 23 , 24 ], but little is known about the long-term outcome among patients with post-SVR HCC. In the current study, we observed that patients with post-SVR HCC had better survival than the patients who developed HCC while having HCV viremia.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed after HCV SVR

Yeh

Liang

Tsai

et al. 2021

Cancers

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The clinical presentation and survival of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication as compared to HCC in viremic patients are not well characterized. We aimed to investigate the characteristics and survival between HCV patients with and without viremia at HCC diagnosis.: We retrospectively analyzed overall survival outcomes in 1389 HCV-related HCC patients, including 301 with HCC developed after HCV eradication (post-SVR HCC) and 1088 with HCV viremia at HCC diagnosis (viremic HCC). We also evaluated overall survival in the two groups using propensity score-matching methods.: At HCC diagnosis, post-SVR HCC patients were older, less obese, less likely cirrhotic, with better liver function, lower alfa-fetoprotein levels, earlier BCLC stages, and higher rate of treatment with surgery. Overall, post-SVR HCC patients had higher median survival than viremic patients (153.3 vs. 55.6 months, p < 0.01), but post-SVR HCC was not independently associated with survival on multivariate analysis (adjusted HR: 1.05, 95% CI: 0.76–1.47). However, on sub-analysis, viremic HCC patients who subsequently received anti-viral treatment and achieved SVR had higher median survival than post-SVR HCC patients (p < 0.01). Viremic HCC with subsequent SVR was also significantly associated with lower mortality as compared to post-SVR HCC (adjusted HR: 0.18, 95% CI: 0.11–0.29). In addition, we observed similar findings in our analysis of the propensity score-matched cohorts.: The advantages in clinical and tumor characters at HCC diagnosis determined the better overall survival of post-SVR HCC patients; however, HCV eradication after HCC development was also associated with improved survival.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed after HCV SVR

Yeh

Liang

Tsai

et al. 2021

Cancers

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“…In a retrospective cohort study for HCC patients in BCLC stage B, the median patient survival time was significantly longer in DAA-treated patients, when compared to that in DAA-untreated patients (40.1 vs. 22.9 months) [26]. Moreover, in a retrospective cohort study for HCC patients in BCLC stage C, whose HCCs were treated with sorafenib, HCV eradication through DAA therapy also confirmed patient survival benefits [27]. However, not all studies demonstrated patient survival benefits as coming from DAA therapy for patients with unresectable HCCs [9].…”

Section: Discussionmentioning

confidence: 96%

Advances in the Era of Direct-Acting Antivirals for Hepatitis C in Patients with Unresectable Hepatocellular Carcinoma

Chen

Lee

Yang

et al. 2021

Dig Dis

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Background: In patients with unresectable hepatocellular carcinoma (HCC), the advances in direct-acting antiviral (DAA) therapy for chronic hepatitis C remain unclear. We aimed to investigate the characteristics of DAA therapy, when compared to interferon (IFN) therapy. Methods: In this hospital-based study, all HCC patients in Barcelona Clinic Liver Cancer (BCLC) stage B or C, who received pegylated IFN or DAA, were retrospectively screened from 2009 to 2020. Patients without viremia, without HCC, or with HCC in BCLC stage 0, A, or D prior to antiviral therapy, were excluded. Rates of, and odds ratio (OR) for sustained virological response (SVR) achievement were analyzed. Results: Nineteen and 78 patients were recruited into the IFN and DAA groups, respectively. The median age was significantly older in the DAA group (DAA vs. IFN: 69.5 [25%-75% IQR: 62.8-77.3] vs. 64.0 [25%-75% IQR: 61.0-68.0]; p< 0.05). The SVR rates were higher in the DAA group as per protocol (DAA vs. IFN: 94.5% vs. 76.5%; p< 0.05) and in BCLC stage B (DAA vs. IFN: 95.2% vs. 76.5%; p< 0.05). All patients in BCLC stage C received DAA therapy, with the SVR rate being 90.9%. In multivariable regression analysis, the 4-week virological response (OR 5.6, 95% CI: 1.3-25.4) and HCC within the up-to-7 criteria (OR 3.7, 95% CI: 1.1-12.9) were independent factors associated with SVR (all p< 0.05). Conclusions: Compared to IFN therapy, more elderly patients with unresectable HCCs were able to receive DAA therapy, while achieving a significantly higher SVR rate.

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“…This study found that treatment with DAAs was highly effective in eradicating HCV in patients with a history of HCC, despite their being older and more likely to have liver fibrosis and diabetes mellitus than patients without a history of HCC. DAAs are also effective in patients with advanced HCC[ 22 - 24 ]. HCV eradication by DAAs ameliorates liver inflammation and suppresses liver fibrosis progression, preserving or improving liver function.…”

Section: Discussionmentioning

confidence: 99%

Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

Tajiri¹,

Ito²,

Kawai³

et al. 2022

WJH

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BACKGROUND Hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients has a high risk of recurrence. Although eradication of HCV is expected to reduce this risk, the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals (DAAs). AIM To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC. METHODS The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals. The frequency and predictors of HCC recurrence/ occurrence after DAA treatment were included in these analyses. The clinical course of HCC before and after DAA treatment was also evaluated. RESULTS HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC. Median recurrence-free survival (RFS) was 1092 d in patients with a history of HCC, and post-DAA HCC recurrence/occurrence was observed in 29 patients (53.7%) with and 5 (1.9%) without a history of HCC over 6 years ( P < 0.001). RFS in patients with a history of HCC did not differ significantly before and after DAA treatment. The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment. Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment. Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy. CONCLUSION DAA therapy in patients infected with HCV is also effective in patients with a history of HCC. Curative treatment for HCC is desirable before DAA therapy. The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy. Careful observation after DAA therapy is required in patients with a history of HCC.

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Eradication of hepatitis C virus preserve liver function and prolong survival in advanced hepatocellular carcinoma patients with limited life expectancy

Cited by 10 publications

References 39 publications

Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed after HCV SVR

Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed after HCV SVR

Advances in the Era of Direct-Acting Antivirals for Hepatitis C in Patients with Unresectable Hepatocellular Carcinoma

Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

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