José Velosa1, Fátima Serejo, Rui Marinho, Joana Nunes, Helena Glória. 1. Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Av Professor Egas Moniz, 1649-035 Lisbon, Portugal. josevelosa@fm.ul.pt
Abstract
BACKGROUND: The effect of a sustained virological response (SVR) to interferon (IFN) on clinical outcomes of hepatitis C virus (HCV)-related cirrhosis is controversial. AIMS: Evaluate the effect of SVR to IFN on the incidence of hepatocellular carcinoma (HCC) and mortality in patients with compensated HCV-induced cirrhosis. METHODS: A cohort of 130 consecutive patients (92 men, mean age 51.7 years) with histologically proven cirrhosis who received one or more courses of IFN monotherapy or combination therapy with ribavirin were analyzed. SVR was defined as undetectable serum HCV RNA by real-time polymerase chain reaction (PCR) 24 weeks after IFN discontinuation. HCC was assessed by alfa-fetoprotein and ultrasound every 6 months. Predictors of clinical outcomes, defined as HCC, orthotopic liver transplantation (OLT) and mortality, were assessed by Cox regression analysis. RESULTS: The mean follow-up was 6.4 ± 4.0 years (range 1-18). HCC developed in 21 patients: one with SVR versus 20 with non-SVR (P = 0.017). Logistic regression analysis showed that non-SVR (odds ratio [OR] = 27.0; confidence interval [CI], 1.6-452.1), male (OR = 11.6; CI, 1.8-75.4), and greater number of treatments (OR = 4.7; CI, 1.4-16.0) increased the probability of HCC development. Multivariate analysis found that SVR was associated with lower risk of HCC (HR 0.09; CI, 0.01-0.77), OLT (HR 0.04; CI, 0.003-0.63) and any event (HR 0.11; CI, 0.02-0.46) as compared to non-SVR. CONCLUSIONS: In compensated HCV-related cirrhosis, SVR markedly reduces the risk of HCC and improves survival. Clearance of the virus should be intensively attempted in these patients.
BACKGROUND: The effect of a sustained virological response (SVR) to interferon (IFN) on clinical outcomes of hepatitis C virus (HCV)-related cirrhosis is controversial. AIMS: Evaluate the effect of SVR to IFN on the incidence of hepatocellular carcinoma (HCC) and mortality in patients with compensated HCV-induced cirrhosis. METHODS: A cohort of 130 consecutive patients (92 men, mean age 51.7 years) with histologically proven cirrhosis who received one or more courses of IFN monotherapy or combination therapy with ribavirin were analyzed. SVR was defined as undetectable serum HCV RNA by real-time polymerase chain reaction (PCR) 24 weeks after IFN discontinuation. HCC was assessed by alfa-fetoprotein and ultrasound every 6 months. Predictors of clinical outcomes, defined as HCC, orthotopic liver transplantation (OLT) and mortality, were assessed by Cox regression analysis. RESULTS: The mean follow-up was 6.4 ± 4.0 years (range 1-18). HCC developed in 21 patients: one with SVR versus 20 with non-SVR (P = 0.017). Logistic regression analysis showed that non-SVR (odds ratio [OR] = 27.0; confidence interval [CI], 1.6-452.1), male (OR = 11.6; CI, 1.8-75.4), and greater number of treatments (OR = 4.7; CI, 1.4-16.0) increased the probability of HCC development. Multivariate analysis found that SVR was associated with lower risk of HCC (HR 0.09; CI, 0.01-0.77), OLT (HR 0.04; CI, 0.003-0.63) and any event (HR 0.11; CI, 0.02-0.46) as compared to non-SVR. CONCLUSIONS: In compensated HCV-related cirrhosis, SVR markedly reduces the risk of HCC and improves survival. Clearance of the virus should be intensively attempted in these patients.
Authors: G Fattovich; G Giustina; F Degos; G Diodati; F Tremolada; F Nevens; P Almasio; A Solinas; J T Brouwer; H Thomas; G Realdi; R Corrocher; S W Schalm Journal: J Hepatol Date: 1997-07 Impact factor: 25.083
Authors: J C Sheu; J L Sung; D S Chen; P M Yang; M Y Lai; C S Lee; H C Hsu; C N Chuang; P C Yang; T H Wang Journal: Gastroenterology Date: 1985-08 Impact factor: 22.682
Authors: Sarah L George; Bruce R Bacon; Elizabeth M Brunt; Kusal L Mihindukulasuriya; Joyce Hoffmann; Adrian M Di Bisceglie Journal: Hepatology Date: 2009-03 Impact factor: 17.425
Authors: M Colombo; R de Franchis; E Del Ninno; A Sangiovanni; C De Fazio; M Tommasini; M F Donato; A Piva; V Di Carlo; N Dioguardi Journal: N Engl J Med Date: 1991-09-05 Impact factor: 91.245
Authors: Ruben Raphael Plentz; Young Nyun Park; André Lechel; Haeryoung Kim; Friederike Nellessen; Britta Heike Eva Langkopf; Ludwig Wilkens; Annarita Destro; Barbara Fiamengo; Michael Peter Manns; Massimo Roncalli; Karl Lenhard Rudolph Journal: Hepatology Date: 2007-04 Impact factor: 17.425
Authors: Tommaso Stroffolini; Piero Luigi Almasio; Marcello Persico; Simona Bollani; Luisa Benvegnù; Giovangiuseppe Di Costanzo; Giuseppe Pastore; Alessio Aghemo; Gianfranca Stornaiuolo; Alessandra Mangia; Pietro Andreone; Maria Stanzione; Giuseppe Mazzella; Giorgio Saracco; Paolo Del Poggio; Savino Bruno Journal: Am J Gastroenterol Date: 2008-07-12 Impact factor: 10.864
Authors: R Cabrera; A R Limaye; P Horne; R Mills; C Soldevila-Pico; V Clark; G Morelli; R Firpi; D R Nelson Journal: Aliment Pharmacol Ther Date: 2012-10-24 Impact factor: 8.171