Hepatitis C Virus Infection, Antiviral Therapy, and Risk of Hepatocellular Carcinoma

Hsu, Yao Chun; Wu, Chun Ying; Lin, Jaw Town

doi:10.1053/j.seminoncol.2014.12.023

Cited by 23 publications

(16 citation statements)

References 105 publications

(64 reference statements)

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“…These benefits attributable to SVR strongly suggest that eradicative treatment of HCV should be administered to patients with compensated HCV cirrhosis as early as possible, given also the recent introduction of IFN‐free regimens based on direct antiviral agents (DAA) which allow SVR in the wide majority of patients . At the same time, that study confirmed that SVR is associated with lower, but not negligible, risk of HCC occurrence, in line with other studies …”

Section: Introductionsupporting

confidence: 84%

“…2,[6][7][8] At the same time, that study confirmed that SVR is associated with lower, but not negligible, risk of HCC occurrence, 6 in line with other studies. [9][10][11][12] To our knowledge, prospective studies with a follow-up allowing proper analysis of the outcome of patients who developed HCC after anti-HCV therapy-also in correlation with SVR or surrounding disease status-are lacking. In addition, an important clinical question still remains unanswered 13 : do patients who developed HCC benefit of HCV eradication by reducing, as a cause of death, the competing risk of cirrhosis progression that ultimately leads to end-stage liver disease (ESLD) independently from anti-HCC treatment?…”

Section: Introductionmentioning

confidence: 99%

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Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus‐related cirrhosis who attained sustained virological response

Bruno

Marco

Iavarone

et al. 2017

Liver International

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Background Few studies examined the outcome of patients with hepatitis C virus (HCV)‐related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer vs end‐stage liver disease (ESLD) and the benefit of HCV eradication remain undefined. This multicentre, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumour recurrence in compensated HCC patients treated with interferon (IFN) according to HCV status since HCC diagnosis. Methods Two groups of patients with HCV‐related cirrhosis and HCC were followed since HCC diagnosis: (i) compensated cirrhotics with prior sustained virological response (SVR) on IFN‐based regimens (N=19); (ii) compensated cirrhotics without SVR (viraemic) (N=156). RESULTS Over a median follow‐up of 3.0 years since the onset of HCC, OS was longer for HCC patients with SVR than for viraemic patients (log‐rank P=.004). The 5‐year OS rate was 65.9% in patients with SVR vs 31.9% in viraemic patients. Similar trends were reported for hepatic decompensation (log‐rank P=.01) and tumour recurrence (log‐rank P=.01). These findings were confirmed at multivariable and propensity score analysis. At propensity analysis, 0/19 compensated patients with SVR died for ESLD vs 7/19 (37%) viraemic patients (P=.004). HCC mortality was similar in the two groups. Conclusions Hepatocellular carcinoma patients with prior SVR and compensated cirrhosis at the time of tumour diagnosis have prolonged OS than viraemic patients. Given the lack of cirrhosis progression, no SVR patient ultimately died for ESLD while this condition appears the main cause of death among viraemic patients.

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Section: Introductionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus‐related cirrhosis who attained sustained virological response

Bruno

Marco

Iavarone

et al. 2017

Liver International

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“…While HCV is an independent major aetiology of HCC, it has not been reported as risk factor among CHB patients on NUCs. We chose not to analyse the effect of HCV treatment because only a small (12.4%) proportion (242 of 1946) of HCV‐infected patients received interferon‐based regimens; direct acting antiviral agent (DAA) was unavailable during the study period.…”

Section: Discussionmentioning

confidence: 97%

Temporal trend and risk determinants of hepatocellular carcinoma in chronic hepatitis B patients on entecavir or tenofovir

Hsu

Lee

et al. 2018

Journal of Viral Hepatitis

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This study aimed to elucidate the temporal change and determinants for the risk of HCC in patients with chronic hepatitis B continuously receiving NUC. Through analysis of the national healthcare database in Taiwan, we screened a total of 65 426 infected patients receiving entecavir or tenofovir for at least 3 months and excluded those with lamivudine, adefovir or telbivudine exposure, malignancy, end-stage renal failure or a diagnosis of HCC within 3 months of starting treatment. Eligible patients (N = 27 820) were followed until HCC occurrence, completion of the allowed 3-year regimen or 31 December 2013. During a median follow-up of 25.1 (12.1-35.6) months, 802 patients developed HCC, with 1-, 2- and 3-year cumulative incidence of 1.82% (95% CI, 1.66-1.99%), 3.05% (95% CI, 2.82-3.28%) and 4.06% (95% CI, 3.77-4.36%), respectively. HCC annual incidence decreased with an adjusted IRR of 0.73 (95% CI, 0.66-0.80) per yearly interval and was associated with cirrhosis (IRR, 10.07; 95% CI, 6.00-16.90 in age <40 years; 4.69; 95% CI, 3.94-5.59 in age ≧40 years), age (IRR, 3.38; 95% CI, 2.10-5.47 for 40-50 years; 6.92; 95% CI, 4.27-11.21 for 50-60 years; 12.50; 95% CI, 7.71-20.25 for ≧60 years; <40 years as reference), male sex (IRR, 1.71; 95% CI, 1.44-2.04), HCV coinfection (IRR, 1.27; 95% CI, 1.02-1.58) and diabetes (IRR, 1.24; 95% CI, 1.05-1.45). In conclusion, the risk of HCC in patients with chronic hepatitis B receiving entecavir or tenofovir declines over time and is determined by cirrhosis, age, male sex, HCV coinfection and diabetes.

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“…18 Routine use of highly potent directly-acting antiviral agents against HCV, particularly in patients with advanced disease, could have decreased the risk of HCC development among high risk HCV patients in Olmsted County in the more recent era. 19, 20 While the burden of HCV-induced HCC appears to be decreasing, the increasing proportion of HBV induced HCCs in the more recent era is notable. Indeed, a recent population based study of the SEER-Medicare linkage database between 2004 and 2009 also showed an increasing trend of HBV associated HCC, with an annual increase of 10 to 11%.…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in the Epidemiology of Hepatocellular Carcinoma in Olmsted County, Minnesota

Yang

Mohammed

Harmsen

et al. 2017

Journal of Clinical Gastroenterology

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Background/Aim The epidemiology of hepatocellular carcinoma (HCC) has changed in the United States (US) recently. The aim of this study is to evaluate the recent trends of HCC epidemiology in the Olmsted County, Minnesota, US. Method Residents aged over 20 with newly diagnosed HCC were identified using the Rochester Epidemiology Project database. Clinical information was compared among patients diagnosed between 2000 and 2009 (era 1) and 2010–2014 (era 2). Result Over 1.6 million person years of follow up, 93 residents were diagnosed with HCC. The mean age was 67 and 71% were male. The age- and sex-adjusted incidence rates were 6.3 and 7.0 per 100,000 person-years in the first and second eras (P=0.64). The proportion with HBV etiology increased from 4% to 21% between the two eras (P<0.01) while there was a trend toward a decreasing proportion of HCV etiology from 42% to 29% (P=0.20). Only 39% of HCC surveillance candidates had HCCs detected under surveillance and 41% of cirrhotic patients had unrecognized cirrhosis at the time of HCC diagnosis. NAFLD was associated with unrecognized cirrhosis and absence of cirrhosis at HCC diagnosis. More than half (56%) of patients presented at BCLC stage C or D and the median survival was 9.7 months. The overall survival had not changed over time. Conclusion The incidence of HCC remained stable after 2010 in Olmsted County. The proportion of HBV-induced HCC increased while there was a trend of decreasing proportion of HCV-induced HCC. The overall survival in community residents with HCC remains poor.

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Hepatitis C Virus Infection, Antiviral Therapy, and Risk of Hepatocellular Carcinoma

Cited by 23 publications

References 105 publications

Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus‐related cirrhosis who attained sustained virological response

Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus‐related cirrhosis who attained sustained virological response

Temporal trend and risk determinants of hepatocellular carcinoma in chronic hepatitis B patients on entecavir or tenofovir

Recent Trends in the Epidemiology of Hepatocellular Carcinoma in Olmsted County, Minnesota

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