Ryoko Yamada1, Naoki Hiramatsu2, Tsugiko Oze1, Ayako Urabe1, Yuki Tahata1, Naoki Morishita3, Takahiro Kodama1, Hayato Hikita1, Ryotaro Sakamori1, Takayuki Yakushijin4, Akira Yamada5, Hideki Hagiwara6, Eiji Mita7, Masahide Oshita8, Toshifumi Itoh9, Hiroyuki Fukui10, Yoshiaki Inui11, Taizo Hijioka12, Masami Inada13, Kazuhiro Katayama14, Shinji Tamura3, Atsuo Inoue4, Yasuharu Imai15, Tomohide Tatsumi1, Toshimitsu Hamasaki16, Norio Hayashi6, Tetsuo Takehara1. 1. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita. 2. Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai. 3. Department of Gastroenterology and Hepatology, Minoh City Hospital, Minoh. 4. Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka. 5. Department of Gastroenterology and Hepatology, Sumitomo Hospital, Osaka. 6. Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Amagasaki. 7. Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka. 8. Department of Gastroenterology and Hepatology, Osaka Police Hospital, Osaka. 9. Department of Gastroenterology and Hepatology, Japan Community Health care Organization Osaka Hospital, Osaka. 10. Department of Gastroenterology and Hepatology, Yao Municipal Hospital, Yao. 11. Department of Gastroenterology and Hepatology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya. 12. Department of Gastroenterology and Hepatology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano. 13. Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Toyonaka. 14. Department of Gastroenterology and Hepatology, Osaka International Cancer Institute, Osaka. 15. Department of Gastroenterology and Hepatology, Ikeda Municipal Hospital, Ikeda. 16. Department of Gastroenterology and Hepatology, Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan.
Abstract
AIM: In patients with chronic hepatitis C, hepatocellular carcinoma (HCC) occurs at a certain frequency, even if a sustained virologic response (SVR) is achieved by antiviral treatment. Old age, liver fibrosis, and high post-treatment α-fetoprotein (AFP) level are typical risk factors of post-SVR HCC. We examined whether the frequencies and factors of HCC in patients with an SVR achieved from interferon treatment changed. Methods Among patients prospectively registered for pegylated interferon and ribavirin treatment, 2021 with an SVR without HCC development during the treatment period were followed up. The mean observation period was 49.5 ± 26.2 months. RESULTS: The multivariable Cox regression analysis showed that older age, diabetes mellitus, advanced liver disease, and higher post-treatment AFP level were the independent risk factors throughout the observation period. The annual occurrence rate of HCC was 0.74% in the third year, 0.54% in the fourth year, and 0.40% in the fifth year; it gradually decreased from the third year. Because the time course hazards for HCC changed at 48 months, we separately analyzed its risk factors before and after this change point. The multivariable Cox regression analysis showed that the four above-mentioned factors were significantly related to HCC development within 4 years. Conversely, the univariable Cox regression analysis only identified diabetes mellitus as a significant factor for HCC development after 4 years. CONCLUSION: The frequency of HCC in hepatitis C patients who achieved an SVR from interferon treatment decreased during the observation period, and its risk factors changed between the early and late periods.
AIM: In patients with chronic hepatitis C, hepatocellular carcinoma (HCC) occurs at a certain frequency, even if a sustained virologic response (SVR) is achieved by antiviral treatment. Old age, liver fibrosis, and high post-treatment α-fetoprotein (AFP) level are typical risk factors of post-SVR HCC. We examined whether the frequencies and factors of HCC in patients with an SVR achieved from interferon treatment changed. Methods Among patients prospectively registered for pegylated interferon and ribavirin treatment, 2021 with an SVR without HCC development during the treatment period were followed up. The mean observation period was 49.5 ± 26.2 months. RESULTS: The multivariable Cox regression analysis showed that older age, diabetes mellitus, advanced liver disease, and higher post-treatment AFP level were the independent risk factors throughout the observation period. The annual occurrence rate of HCC was 0.74% in the third year, 0.54% in the fourth year, and 0.40% in the fifth year; it gradually decreased from the third year. Because the time course hazards for HCC changed at 48 months, we separately analyzed its risk factors before and after this change point. The multivariable Cox regression analysis showed that the four above-mentioned factors were significantly related to HCC development within 4 years. Conversely, the univariable Cox regression analysis only identified diabetes mellitus as a significant factor for HCC development after 4 years. CONCLUSION: The frequency of HCC in hepatitis C patients who achieved an SVR from interferon treatment decreased during the observation period, and its risk factors changed between the early and late periods.
Authors: Cristina Maria Muzica; Carol Stanciu; Laura Huiban; Ana-Maria Singeap; Catalin Sfarti; Sebastian Zenovia; Camelia Cojocariu; Anca Trifan Journal: World J Gastroenterol Date: 2020-11-21 Impact factor: 5.742