Hansen Dang1,2, Yee Hui Yeo1, Satoshi Yasuda3, Chung-Feng Huang4, Etsuko Iio5, Charles Landis6, Dae Won Jun7, Masaru Enomoto8, Eiichi Ogawa9, Pei-Chien Tsai4, An Le1, Matthew Liu6, Mayumi Maeda1, Brian Nguyen1, Nathan Ramrakhiani1, Linda Henry1, Ramsey Cheung1,10, Akihiro Tamori8, Takashi Kumada3, Yasuhito Tanaka5, Ming-Lung Yu4, Hidenori Toyoda3, Mindie H Nguyen1. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA. 2. University of California, Davis, Davis, CA. 3. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 4. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 5. Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 6. Department of Gastroenterology, University of Washington Medical Center, Seattle, WA. 7. Department of Gastroenterology, Hanyang University, Seoul, South Korea. 8. Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan. 9. Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan. 10. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
Abstract
BACKGROUND AND AIMS: Survival data among patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) with interferon-free direct-acting antivirals (DAAs) in both Asian and western countries are limited. Survival rates were compared between patients with HCV-related HCC who were untreated for HCV and those who achieved SVR. APPROACH AND RESULTS: Using data from two U.S. and six Asian centers from 2005 to 2017, we categorized 1,676 patients who were mono-infected with HCV-related HCC into patients untreated for HCV (untreated group) and DAA-treated patients with SVR (SVR group) and matched by propensity score matching (PSM); multivariable Cox regression with HCV treatment status as a time-varying covariate was used to determine mortality risk and landmark analysis to avoid immortal time bias. There were 1,239 untreated patients and 437 patients with SVR. After PSM, background risks of the 321 pairs of matched patients were balanced (all P > 0.05). After time-varying adjustment for HCV treatment initiation compared with untreated patients, patients with SVR had significantly higher 5-year overall survival (87.78% vs. 66.05%, P < 0.001). Multivariable Cox regression showed that SVR was independently associated with a 63% lower risk of 5-year all-cause mortality (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.16-0.83; P = 0.016) and 66% lower risk of 5-year liver-related mortality (HR, 0.34; 95% CI, 0.13-0.88; P = 0.026) with similar trends after removing patients with liver transplants. Landmark analysis at 90, 180, and 360 days showed consistent results (HRs ranged 0.22 to 0.44, all P < 0.05). CONCLUSION: In this multinational consortium, patients with HCV-related HCC who obtained SVR achieved a 60%-70% improvement in 5-year survival (both all-cause and liver related) compared with patients untreated for HCV. Patients eligible for HCC therapy should also be considered for DAA therapy.
BACKGROUND AND AIMS: Survival data among patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) with interferon-free direct-acting antivirals (DAAs) in both Asian and western countries are limited. Survival rates were compared between patients with HCV-related HCC who were untreated for HCV and those who achieved SVR. APPROACH AND RESULTS: Using data from two U.S. and six Asian centers from 2005 to 2017, we categorized 1,676 patients who were mono-infected with HCV-related HCC into patients untreated for HCV (untreated group) and DAA-treated patients with SVR (SVR group) and matched by propensity score matching (PSM); multivariable Cox regression with HCV treatment status as a time-varying covariate was used to determine mortality risk and landmark analysis to avoid immortal time bias. There were 1,239 untreated patients and 437 patients with SVR. After PSM, background risks of the 321 pairs of matched patients were balanced (all P > 0.05). After time-varying adjustment for HCV treatment initiation compared with untreated patients, patients with SVR had significantly higher 5-year overall survival (87.78% vs. 66.05%, P < 0.001). Multivariable Cox regression showed that SVR was independently associated with a 63% lower risk of 5-year all-cause mortality (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.16-0.83; P = 0.016) and 66% lower risk of 5-year liver-related mortality (HR, 0.34; 95% CI, 0.13-0.88; P = 0.026) with similar trends after removing patients with liver transplants. Landmark analysis at 90, 180, and 360 days showed consistent results (HRs ranged 0.22 to 0.44, all P < 0.05). CONCLUSION: In this multinational consortium, patients with HCV-related HCC who obtained SVR achieved a 60%-70% improvement in 5-year survival (both all-cause and liver related) compared with patients untreated for HCV. Patients eligible for HCC therapy should also be considered for DAA therapy.
Authors: Jin Hean Koh; Darren Jun Hao Tan; Yuki Ong; Wen Hui Lim; Cheng Han Ng; Phoebe Wen Lin Tay; Jie Ning Yong; Mark D Muthiah; Eunice X Tan; Ning Qi Pang; Beom Kyung Kim; Nicholas Syn; Alfred Kow; Brian K P Goh; Daniel Q Huang Journal: Hepatobiliary Surg Nutr Date: 2022-02 Impact factor: 8.265
Authors: María Teresa Arias-Loste; Joaquín Cabezas; Susana Llerena; Paula Iruzubieta; David San-Segundo; David Merino; Antonio Cuadrado; José Pedro Vaqué; Marcos López-Hoyos; Javier Crespo Journal: Viruses Date: 2021-04-07 Impact factor: 5.048
Authors: Michael K Turgeon; Rachel M Lee; Adriana C Gamboa; Adam Yopp; Emily L Ryon; Neha Goel; Annie Wang; Ann Y Lee; Sommer Luu; Cary Hsu; Eric Silberfein; Shishir K Maithel; Maria C Russell Journal: HPB (Oxford) Date: 2020-08-07 Impact factor: 3.647
Authors: Mark S Sulkowski; Juhi S Moon; Kenneth E Sherman; Giuseppe Morelli; Jama M Darling; Andrew J Muir; Mandana Khalili; Dawn A Fishbein; Federico Hinestrosa; Mitchell L Shiffman; Adrian Di Bisceglie; K Rajender Reddy; Brian Pearlman; Anna S Lok; Michael W Fried; Paul W Stewart; Joy Peter; Summer Wadsworth; Scott Kixmiller; Anquenette Sloan; Monika Vainorius; Patrick M Horne; Larry Michael; Meichen Dong; Donna M Evon; Jodi B Segal; David R Nelson Journal: Hepatology Date: 2021-08-26 Impact factor: 17.425