Liver Fibrosis and Body Mass Index Predict Hepatocarcinogenesis following Eradication of Hepatitis C Virus RNA by Direct-Acting Antivirals

Akuta, Norio; Kobayashi, Masahiro; Suzuki, Fumitaka; Sezaki, Hitomi; Fujiyama, Shunichiro; Kawamura, Yusuke; Hosaka, Tetsuya; Kobayashi, Mariko; Saitoh, Satoshi; Suzuki, Yoshiyuki; Arase, Yasuji; Ikeda, Kenji; Kumada, Hiromitsu

doi:10.1159/000450551

Cited by 28 publications

(22 citation statements)

References 31 publications

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“…In the present study, the estimated annual incidence of HCC for the first 2 years under all-oral direct-acting antiviral regimens was 0.9%. We have also shown that the HCC rate following direct-acting antiviral regimens was not different from that following interferon treatment in patients who achieved SVR [24,25] . In the present study, we compared HCC development rates between direct-acting antiviral regimens ( n = 1,065) and 24 weeks of NS3/4A protease inhibitor (telaprevir or simeprevir)/peginterferon/ ribavirin regimens ( n = 331) in patients who achieved SVR.…”

Section: Discussionmentioning

confidence: 67%

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Outcome of All-Oral Direct-Acting Antiviral Regimens on the Rate of Development of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Genotype 1-Related Chronic Liver Disease

Ogata¹,

Kobayashi²,

Akuta³

et al. 2017

Oncology

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Objectives: There is little information on the risk factors for hepatocellular carcinoma (HCC) and outcome of treatment with an all-oral combination of direct-acting antiviral regimens following eradication of hepatitis C virus (HCV) RNA. Methods: The study subjects were 1,170 patients with HCV genotype 1-related chronic liver disease treated with either NS5A inhibitor plus NS3/4A protease inhibitor (n = 707), NS5A inhibitor plus NS5B polymerase inhibitor (n = 345), or NS5A inhibitor, NS3/4A protease inhibitor plus ritonavir (n = 118), for 12-24 weeks. All patients were free of HCC before and during therapy. Results: In this retrospective study, 22 patients developed HCC during the follow-up (time from the end of antiviral therapy until the last visit: 1.3 years). At 1 and 2 years after completion of the treatment, the cumulative HCC rates for the whole group were 1.8 and 2.3%, respectively, and 1.4 and 1.8%, respectively, for 1,065 patients who showed sustained virological response (SVR). The risk factors for HCC identified by multivariate analysis were hypoalbuminemia, thrombocytopenia, a high α-fetoprotein level, and non-SVR for all patients, and hypoalbuminemia and a high α-fetoprotein level for patients with SVR. Conclusion: Eradication of HCV RNA by direct-acting antiviral regimens might reduce the risk of HCC. Albumin and α-fetoprotein levels are significant risk factors for HCC.

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Section: Discussionmentioning

confidence: 67%

“…Previous studies from our laboratories showed that SVR, regardless of the type of treatment, reduced the chance of development of HCC [24,25] . Our study also determined the cumulative HCC rate and the risk factors for HCC in patients under treatment with all-oral combinations of direct-acting antiviral regimens.…”

Section: Discussionmentioning

confidence: 92%

Outcome of All-Oral Direct-Acting Antiviral Regimens on the Rate of Development of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Genotype 1-Related Chronic Liver Disease

Ogata¹,

Kobayashi²,

Akuta³

et al. 2017

Oncology

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“…Further studies should be performed to evaluate the relationship between CAP and lipid metabolism. Interestingly, clinical evidence suggest a link between obesity and HCC after SVR, but body weight was not measured regularly in the present study. Considered with the above findings, further studies are required to investigate the relation between changes in CAP following DAA treatment and HCC.…”

Section: Discussionmentioning

confidence: 99%

Serial changes in liver stiffness and controlled attenuation parameter following direct‐acting antiviral therapy against hepatitis C virus genotype 1b

Ogasawara

Kobayashi

Akuta

et al. 2017

Journal of Medical Virology

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Little information is available on the impact of direct-acting antiviral (DAA) therapy on changes in liver fibrosis and steatosis. Liver stiffness (LS) and controlled attenuation parameter (CAP) values were evaluated using transient elastography. The study subjects were 214 elderly patients infected with HCV genotype 1b who received 24-week daclatasvir and asunaprevir dual therapy. All patients of this retrospective study had no hepatocellular carcinoma before and during DAA therapy. LS and CAP were assessed before treatment (baseline), at end of treatment (EOT), and at 24, 48, 72 weeks (W) after EOT. The rate of sustained viral response (SVR) by daclatasvir and asunaprevir therapy was 91%. LS values for the entire group correlated with Fib-4 index at baseline (r = 0.565, P < 0.001). LS in both chronic hepatitis group (Fib-4 index <3.25) and cirrhosis group (Fib-4 index ≥3.25) decreased significantly at each time point compared with baseline (P < 0.001). Especially, a larger decrease in LS from baseline to EOT was seen in the cirrhosis group than chronic hepatitis group (P < 0.001). LS was also significantly lower in the SVR group at EOT, 24W, 48W, 72W compared with baseline (P < 0.001). Even in the non-SVR group, LS tended to be lower at EOT (P = 0.039), 24W (P = 0.009), 48W (P = 0.475), 72W (P = 0.033) compared with baseline. CAP increased significantly following the treatment from baseline to 48W post-EOT (P = 0.018). Our results showed significant improvement in LS in response to daclatasvir and asunaprevir dual therapy. In the other hand, there was a tendency that CAP increased from baseline.

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“…Certain studies have established the correlation between the degree of liver fibrosis and HCC [19, 20]. Cirrhotic patients with complications are in decompensated states.…”

Section: Discussionmentioning

confidence: 99%

Association between complicated liver cirrhosis and the risk of hepatocellular carcinoma in Taiwan

et al. 2017

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Hepatic encephalopathy, ascites, and variceal bleeding are the three major complications of cirrhosis. It is well known that cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC). However, little is known about whether the severity of liver cirrhosis has an effect on the incidence of HCC. This population-based cohort study aimed to explore the association between complicated cirrhosis and HCC, and identify the risk factors of HCC in patients with complicated cirrhosis. Data of the years 1997–2011 were extracted from the National Health Insurance Research Database of Taiwan. A total of 2568 patients with complicated cirrhosis without HCC at baseline were enrolled. After propensity score matching, another 2568 patients with non-complicated cirrhosis were included. Hazards Cox regression analysis by using a competing risk regression model to control for possible confounding factors was utilized to estimate the association of the complications of liver cirrhosis with the risk of HCC. We observed by using competing risk analysis that the adjusted hazard ratio (HR) for developing HCC during the follow-up period after the initial hospitalization was higher among the patients with baseline complicated cirrhosis than in those with uncomplicated cirrhosis (HR, 1.23; 95% confidence interval, CI, 1.10–1.37, p<0.001). Additionally, older patients (HR, 1.01; 95% CI, 1.01–1.02, p<0.001), males (HR, 0.84; 95% CI, 0.74–0.96, p = 0.009), and patients with alcohol-related cirrhosis (HR, 1.93; 95% CI, 1.65–2.26, p<0.001) had a statistically significant difference in the incidence of HCC. In conclusion, complicated liver cirrhosis is associated with a higher risk of HCC in Taiwan compared with cirrhosis without complications.

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Liver Fibrosis and Body Mass Index Predict Hepatocarcinogenesis following Eradication of Hepatitis C Virus RNA by Direct-Acting Antivirals

Cited by 28 publications

References 31 publications

Outcome of All-Oral Direct-Acting Antiviral Regimens on the Rate of Development of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Genotype 1-Related Chronic Liver Disease

Outcome of All-Oral Direct-Acting Antiviral Regimens on the Rate of Development of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Genotype 1-Related Chronic Liver Disease

Serial changes in liver stiffness and controlled attenuation parameter following direct‐acting antiviral therapy against hepatitis C virus genotype 1b

Association between complicated liver cirrhosis and the risk of hepatocellular carcinoma in Taiwan

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