Long-Term Prognostic Factors after Hepatic Resection for Hepatitis C Virus-Related Hepatocellular Carcinoma, with a Special Reference to Viral Status

Abstract

Background: Although studies have reported on long-term (10-year) survival after hepatic resection for hepatocellular carcinoma (HCC), they did not focus on patients with hepatitis C virus (HCV)-related HCC, and the contribution of antiviral therapy to long-term survival (especially ≥15 years) has not been adequately examined. We investigated the long-term outcome after hepatic resection for HCV-related HCC, including the effects of interferon (IFN) therapy, and the changes in prognostic factors according to postoperative duration. Methods: The data of 207 patients who underwent hepatic resection for HCV-related HCC between January 1992 and December 2001 were retrospectively reviewed. We investigated the disease-free and overall survival rates after surgery and analyzed the prognostic factors at 5, 10, and 15 years postoperatively. Results: The proportion of patients who survived at 5, 10, and 15 years after hepatic resection was 52% (n = 107), 18% (n = 38), and 9% (n = 19). The overall survival rate was significantly higher in patients who achieved sustained virological response (SVR) with IFN therapy than in those without SVR. Tumor-related factors such as multiple tumor, microscopic vascular invasion, and a high indocyanine green retention rate at 15 min (ICGR15) were unfavorable prognostic factors for 5-year survival. Conversely, a low ICGR15 and SVR were favorable prognostic factors at 10 years, and SVR alone was a favorable prognostic factor at 15 years postoperatively; no tumor-related factors were prognostic factors at 10 and 15 years postoperatively. Conclusion: The prognostic factors varied according to the duration after hepatic resection for HCV-related HCC. Tumor-related factors were unfavorable prognostic factors in the early postoperative period, whereas SVR and good liver function were favorable prognostic factors at 10 and 15 years postoperatively. Achievement of SVR with IFN therapy is essential for long-term (≥15 years) survival after hepatic resection for HCVrelated HCC.

Surgical outcomes for hepatocellular carcinoma detected after hepatitis C virus eradiation by direct‐acting antivirals

“…4,33 Moreover, IBT-SVR was reported to improve the OS rate and decrease the proportion of deaths by liver failure. 4,5,9 In this study, although the follow-up period was relatively short, there was no marked difference in the patients with postoperative recurrence within 1 year after surgery between the two groups, even in the PSM cohort. Furthermore, none of the patients in the DAA group experienced postoperative recurrence over 3 years after liver resection.…”

“…2,3 In addition, there is a high recurrence rate after curative treatment for HCV-related HCC, with a cumulative recurrence rate of 60% to 90% 5 years after hepatic resection. [4][5][6] There is a particularly high rate of multicentric occurrence, which typically appears during the late postoperative period (2-3 years) after liver resection. 7 Previous reports indicate that sustained virologic response (SVR) induced by interferon-based therapy (IBT) decreases postoperative HCC recurrence after liver resection, especially during the late postoperative period.…”

“…4,8 Moreover, the maintenance of good liver function after IBT-induced SVR (IBT-SVR) increases the opportunity for curative treatment (repeat liver resection or ablation therapy), improving long-term survival rates. 4,5,9 Direct-acting antivirals (DAA) therapy, an alternative to IBT that achieves a high rate of SVR (≥95%), has been established as a standard treatment for patients with HCV infection. DAA therapy has gained popularity since insurance coverage was established for the treatment on 2 September 2014 in Japan.…”

“…Follow-up evaluationsAll patients attended follow-up appointments every 3 months after discharge for 5 years following hepatic resection, then every 3 to 6 months thereafter 4,5. The follow-up evaluations included a physical examination, liver function tests, chest radiographs or chest-computed tomography to check for pulmonary metastases; ultrasonography,computed tomography, or magnetic resonance imaging to check for recurrence in the remnant liver or other organs.…”

Two Cases of Hepatocellular Carcinoma Arising Over 20 Years after a Sustained Virologic Response Following Interferon Therapy for Chronic Hepatitis C

“…Successful IFN treatment is known to improve the prognosis of patients with CHC by suppressing the incidence of HCC and preventing the progression of liver fibrosis. In addition, preserving the liver function by achieving an SVR enables radical treatment for HCC to be performed, resulting in a favorable prognosis ( 16 - 18 ). Several studies have recently addressed the association between a lack of surveillance after an SVR and more advanced HCC at detection, resulting in a poor prognosis ( 19 - 21 ).…”