Impact of etiological treatment on prognosis

Abstract

Portal hypertension (PHT) is a frequent and severe complication of cirrhosis. PHT may lead to the development of various complications with high mortality. Liver transplantation is the gold standard as a surgical curative treatment for end-stage liver disease. Theoretically, etiological treatment focusing on the pathophysiology of the underlying disease should be the objective of the nonsurgical management of cirrhotic PHT. Chronic viral hepatitis is the major etiology of cirrhosis and PHT. In cirrhotic patients with chronic hepatitis B virus infection, antiviral therapies can suppress viral replication, ameliorate hepatic inflammation, regress fibrosis, and restore liver functional reserve. Moreover, they can delay the progression of liver cirrhosis and ameliorate the severity of PHT. In patients with hepatitis C virus-induced liver cirrhosis, interferon and ribavirin combination therapy provide a favorable long-term prognosis, including lower rates of liver-related and non-liver-related deaths, hepatic decompensation, and hepatocellular carcinoma, particularly in those who have successful eradication of the virus after therapy. In patients with PHT, direct antivirals (DAAs) for hepatitis C virus infection have good safety profiles and excellent viral suppression. Moreover, DAAs can reduce hepatic venous pressure gradient. However, these effects are stronger during the earlier stage of liver cirrhosis. Abstinence is the cornerstone of etiological treatment for alcoholic liver disease. The effects of pharmacological treatments are not satisfactory, and additional studies are mandatory.

Incidence, prevalence and risk factors for hepatitis C in Danish prisons

“…Well tolerated therapies for CHC with cure rates above 95% are now available [3]. Treatment leading to sustained virological response (SVR) is associated with decrease in liver stiffness [4, 5] and a reduction in the risk of progressing to cirrhosis, HCC and end-stage liver disease [6, 7].…”

Construction of a 13‐microRNA‐based signature and prognostic nomogram for predicting overall survival in patients with hepatocellular carcinoma

“…Other patients with a clear cause of HCC have the advantage of prognosis, which indicates that HCC patients could prolong their OS after accepting treatments based on disease etiology. Many reports have shown that treatments based on etiology are beneficial to improve HCC patients’ prognosis 30–34 . In order to identify the prognostic value of the constructed model, we tested an internal cohort, and the results were consistent with those of the primary cohort.…”

“…Many reports have shown that treatments based on etiology are beneficial to improve HCC patients' prognosis. [30][31][32][33][34] In order to identify the prognostic value of the constructed model, we tested an internal cohort, and the results were consistent with those of the primary cohort. Furthermore, even when we divided the whole cohort into a 2:1 ratio, as for training and validation, the results were indistinguishable (data not shown).…”

Factors predicting long-term outcome of early stage hepatocellular carcinoma after primary curative treatment - the role of surgical or nonsurgical methods

“…Similarly, the results of the present study demonstrated this point that CSPH was associated with increases in mortality of 1.97-fold. More and more evidence has suggested that antiviral therapies could reduce hepatic venous pressure gradient but these effects were limited to those with earlier stage of liver cirrhosis [32,33]. The presence of CSPH in patients with early stage HCC may imply the consideration of liver transplantation before recurrence.…”