Savino Bruno1, Vito Di Marco2, Massimo Iavarone3, Luigi Roffi4, Vincenzo Boccaccio1, Andrea Crosignani5, Giuseppe Cabibbo2, Sonia Rossi1, Vincenza Calvaruso2, Alessio Aghemo3, Luca Giacomelli6, Antonio Craxì2, Massimo Colombo3, Patrick Maisonneuve7. 1. Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Italy. 2. Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy. 3. Gastroenterology and Hepatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. Department of Medicine, ASST Nord Milano, Milan, Italy. 5. Department of Internal Medicine, A.O. Santi Paolo e Carlo, Milan, Italy. 6. Department of Surgery and Integrated Diagnostics, University of Genoa, Genoa, Italy. 7. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
Abstract
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.
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 carcinomapatients 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.
Authors: Nicole E Rich; Ju Dong Yang; Ponni V Perumalswami; Naim Alkhouri; Whitney Jackson; Neehar D Parikh; Neil Mehta; Reena Salgia; Andres Duarte-Rojo; Laura Kulik; Mina Rakoski; Adnan Said; Omobonike Oloruntoba; George N Ioannou; Maarouf A Hoteit; Andrew M Moon; Amol S Rangnekar; Sheila L Eswaran; Elizabeth Zheng; Janice H Jou; James Hanje; Anjana Pillai; Ruben Hernaez; Robert Wong; Steven Scaglione; Hrishikesh Samant; Devika Kapuria; Shaun Chandna; Russell Rosenblatt; Veeral Ajmera; Catherine T Frenette; Sanjaya K Satapathy; Parvez Mantry; Prasun Jalal; Binu V John; Oren K Fix; Michael Leise; Christina C Lindenmeyer; Avegail Flores; Nayan Patel; Z Gordon Jiang; Nyan Latt; Renumathy Dhanasekaran; Mobolaji Odewole; Sofia Kagan; Jorge A Marrero; Amit G Singal Journal: Clin Gastroenterol Hepatol Date: 2019-07-26 Impact factor: 11.382
Authors: Amit G Singal; Nicole E Rich; Neil Mehta; Andrea D Branch; Anjana Pillai; Maarouf Hoteit; Michael Volk; Mobolaji Odewole; Steven Scaglione; Jennifer Guy; Adnan Said; Jordan J Feld; Binu V John; Catherine Frenette; Parvez Mantry; Amol S Rangnekar; Omobonike Oloruntoba; Michael Leise; Janice H Jou; Kalyan Ram Bhamidimarri; Laura Kulik; George N Ioannou; Annsa Huang; Tram Tran; Hrishikesh Samant; Renumathy Dhanasekaran; Andres Duarte-Rojo; Reena Salgia; Sheila Eswaran; Prasun Jalal; Avegail Flores; Sanjaya K Satapathy; Sofia Kagan; Purva Gopal; Robert Wong; Neehar D Parikh; Caitlin C Murphy Journal: Gastroenterology Date: 2019-07-30 Impact factor: 22.682
Authors: Hye Kyong Park; Sang Soo Lee; Chang Bin Im; Changjo Im; Ra Ri Cha; Wan Soo Kim; Hyun Chin Cho; Jae Min Lee; Hyun Jin Kim; Tae Hyo Kim; Woon Tae Jung; Ok-Jae Lee Journal: BMC Cancer Date: 2019-08-20 Impact factor: 4.430