Amit G Singal1, Nicole E Rich2, Neil Mehta3, Andrea Branch4, Anjana Pillai5, Maarouf Hoteit6, Michael Volk7, Mobolaji Odewole2, Steven Scaglione8, Jennifer Guy9, Adnan Said10, Jordan J Feld11, Binu V John12, Catherine Frenette13, Parvez Mantry14, Amol S Rangnekar15, Omobonike Oloruntoba16, Michael Leise17, Janice H Jou18, Kalyan Ram Bhamidimarri19, Laura Kulik20, Tram Tran21, Hrishikesh Samant22, Renumathy Dhanasekaran23, Andres Duarte-Rojo24, Reena Salgia25, Sheila Eswaran26, Prasun Jalal27, Avegail Flores28, Sanjaya K Satapathy29, Robert Wong30, Annsa Huang3, Suresh Misra4, Myron Schwartz4, Robert Mitrani6, Sasank Nakka7, Wassim Noureddine7, Chanda Ho9, Venkata R Konjeti12, Alexander Dao15, Kevin Nelson17, Kelly Delarosa21, Usman Rahim23, Meher Mavuram22, Jesse J Xie24, Caitlin C Murphy2, Neehar D Parikh31. 1. Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas. Electronic address: amit.singal@utsouthwestern.edu. 2. Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas. 3. Division of Gastroenterology, University of California San Francisco, San Francisco, California. 4. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois. 6. Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California. 8. Division of Hepatology, Loyola University Medical Center, Chicago, Illinois; Edward Hines Veterans Affairs, Chicago, Illinois. 9. Department of Transplantation, California Pacific Medical Center, San Francisco, California. 10. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin. 11. Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada. 12. Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia. 13. Division of Organ Transplantation, Scripps Green Hospital, San Diego, California. 14. Liver Institute at Methodist Dallas, Dallas, Texas. 15. Division of Gastroenterology, Georgetown University Hospital, Washington, DC. 16. Division of Gastroenterology and Hepatology, Duke University Health Center, Durham, North Carolina. 17. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 18. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon. 19. Division of Hepatology, University of Miami Miller School or Medicine, Miami, Florida. 20. Division of Hepatology, Northwestern University, Chicago, Illinois. 21. Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California. 22. Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana. 23. Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California. 24. Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 25. Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan. 26. Division of Gastroenterology, Rush Medical College, Chicago, Illinois. 27. Division of Abdominal Transplantation, Baylor College of Medicine, Dallas, Texas. 28. Division of Gastroenterology, Washington University School of Medicine, Louis, Missouri. 29. Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. 30. Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California. 31. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND & AIMS: There is controversy over the effects of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection on hepatocellular carcinoma (HCC) recurrence and tumor aggressiveness. We compared HCC recurrence patterns between DAA-treated and untreated HCV-infected patients who had achieved a complete response to HCC treatment in a North American cohort. METHODS: We conducted a retrospective cohort study of patients with HCV-related HCC with a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy from January 2013 through December 2017 at 31 health systems throughout the United States and Canada. Cox regression was used to examine the association between DAA therapy and time to recurrence after a complete response, with DAA therapy analyzed as a time-varying exposure. We also estimated the association between DAA therapy and risk of early HCC recurrence (defined as 365 days after complete response). RESULTS: Of 793 patients with HCV-associated HCC, 304 (38.3%) received DAA therapy and 489 (61.7%) were untreated. HCC recurred in 128 DAA-treated patients (42.1%; early recurrence in 52 patients) and 288 untreated patients (58.9%; early recurrence in 227 patients). DAA therapy was not associated with HCC recurrence (hazard ratio 0.90, 95% confidence interval 0.70-1.16) or early HCC recurrence (hazard ratio 0.96, 95% confidence interval 0.70-1.34) after we adjusted for study site, age, sex, Child-Pugh score, α-fetoprotein level, tumor burden, and HCC treatment modality. In DAA-treated and untreated patients, most recurrences were within the Milan criteria (74.2% vs 78.8%; P = .23). A larger proportion of DAA-treated than untreated patients received potentially curative HCC therapy for recurrent HCC (32.0% vs 24.6%) and achieved a complete or partial response (45.3% vs 41.0%) but this did not achieve statistical significance. CONCLUSION: In a large cohort of North American patients with complete response to HCC treatment, DAA therapy was not associated with increased overall or early HCC recurrence. HCC recurrence patterns, including treatment response, were similar in DAA-treated and untreated patients.
BACKGROUND & AIMS: There is controversy over the effects of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection on hepatocellular carcinoma (HCC) recurrence and tumor aggressiveness. We compared HCC recurrence patterns between DAA-treated and untreated HCV-infectedpatients who had achieved a complete response to HCC treatment in a North American cohort. METHODS: We conducted a retrospective cohort study of patients with HCV-related HCC with a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy from January 2013 through December 2017 at 31 health systems throughout the United States and Canada. Cox regression was used to examine the association between DAA therapy and time to recurrence after a complete response, with DAA therapy analyzed as a time-varying exposure. We also estimated the association between DAA therapy and risk of early HCC recurrence (defined as 365 days after complete response). RESULTS: Of 793 patients with HCV-associated HCC, 304 (38.3%) received DAA therapy and 489 (61.7%) were untreated. HCC recurred in 128 DAA-treated patients (42.1%; early recurrence in 52 patients) and 288 untreated patients (58.9%; early recurrence in 227 patients). DAA therapy was not associated with HCC recurrence (hazard ratio 0.90, 95% confidence interval 0.70-1.16) or early HCC recurrence (hazard ratio 0.96, 95% confidence interval 0.70-1.34) after we adjusted for study site, age, sex, Child-Pugh score, α-fetoprotein level, tumor burden, and HCC treatment modality. In DAA-treated and untreated patients, most recurrences were within the Milan criteria (74.2% vs 78.8%; P = .23). A larger proportion of DAA-treated than untreated patients received potentially curative HCC therapy for recurrent HCC (32.0% vs 24.6%) and achieved a complete or partial response (45.3% vs 41.0%) but this did not achieve statistical significance. CONCLUSION: In a large cohort of North American patients with complete response to HCC treatment, DAA therapy was not associated with increased overall or early HCC recurrence. HCC recurrence patterns, including treatment response, were similar in DAA-treated and untreated patients.
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Authors: Amit G Singal; Michael L Volk; Donald Jensen; Adrian M Di Bisceglie; Philip S Schoenfeld Journal: Clin Gastroenterol Hepatol Date: 2009-11-27 Impact factor: 11.382
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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