Tatsuya Minami1, Ryosuke Tateishi1, Naoto Fujiwara1, Ryo Nakagomi1, Takuma Nakatsuka1, Masaya Sato1, Koji Uchino1, Kenichiro Enooku1, Hayato Nakagawa1, Hidetaka Fujinaga1, Masashi Izumiya1, Kazuyuki Hanajiri1,2, Yoshinari Asaoka1,3, Yuji Kondo1,4, Yasuo Tanaka1, Motoyuki Otsuka1, Takamasa Ohki5, Masahiro Arai6, Atsushi Tanaka3, Kiyomi Yasuda7, Hideaki Miura8, Itsuro Ogata9, Toshiro Kamoshida10, Kazuaki Inoue11, Yukihiro Koike12, Masatoshi Akamatsu13, Hiroshi Mitsui14, Hajime Fujie15, Keiji Ogura16, Hideo Yoshida17, Tomonori Wada2, Kiyohiko Kurai18, Hisato Maekawa19, Shuntaro Obi4, Takuma Teratani20, Naohiko Masaki21, Kayo Nagashima22, Takashi Ishikawa23, Naoya Kato1, Kyoji Moriya1, Hiroshi Yotsuyanagi24, Kazuhiko Koike1. 1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 2. Department of Gastroenterology, Sanraku Hospital, Tokyo, Japan. 3. Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan. 4. Department of Gastroenterology and Hepatology, Kyoundo Hospital, Tokyo, Japan. 5. Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan. 6. Department of Gastroenterology, Toshiba General Hospital, Toshiba, Japan. 7. Department of Gastroenterology, Kiyokawa Hospital, Tokyo, Japan. 8. Department of Gastroenterology, Tokyo Yamate Medical Center, Tokyo, Japan. 9. Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan. 10. Department of Gastroenterology, Hitachi General Hospital, Hitachi, Japan. 11. Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan. 12. Department of Gastroenterology, Kanto Central Hospital of the Mutual Aid Association of Public School Teacher, Tokyo, Japan. 13. Department of Gastroenterology, JR Tokyo General Hospital, Tokyo, Japan. 14. Department of Gastroenterology, Tokyo Teishin Hospital, Tokyo, Japan. 15. Department of Gastroenterology, Tokyo Shinjuku Medical Center, Tokyo, Japan. 16. Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan. 17. Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan. 18. Kurai Kiyohiko Medical Clinic, Utsunomiya, Japan. 19. Department of Gastroenterology and Hepatology, Tokyo Takanawa Hospital, Tokyo, Japan. 20. Department of Hepato-Biliary-Pancreatic medicine, NTT Medical Center Tokyo, Tokyo, Japan. 21. Clinical Laboratory Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan. 22. Department of Gastroenterology, National Disaster Medical Center, Tachikawa, Japan. 23. Marunouchi Clinic, Tokyo, Japan. 24. Division of Infectious Disease and Applied Immunology, The Institute of Medical Science Research Hospital, The University of Tokyo, Tokyo, Japan.
Abstract
BACKGROUND AND AIMS: It remains unclear whether obesity increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C who achieved a sustained virological response (SVR) with antiviral therapy. METHODS: In this multicenter cohort study, we enrolled patients with chronic hepatitis C who achieved SVR with interferon (IFN)-based therapy (IFN group) or direct-acting antiviral (DAA) therapy (DAA group) between January 1, 1990, and December 31, 2018. The patients underwent regular surveillance for HCC. Cumulative incidence of and the risk factors for HCC development after SVR were assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis, respectively. RESULTS: Among 2,055 patients (840 in the IFN group and 1,215 in the DAA group), 75 developed HCC (41 in the IFN group and 34 in the DAA group) during the mean observation period of 4.1 years. The incidence rates of HCC at 1, 2, and 3 years were 1.2, 1.9, and 3.0%, respectively. Multivariate analysis revealed that in addition to older age, lower albumin level, lower platelet count, higher alpha-fetoprotein level, and absence of dyslipidemia, obesity (body mass index ≥25 kg/m2) and heavy alcohol consumption (≥60 g/day) were independent risk factors for HCC development, with adjusted hazard ratio (HR) of 2.53 (95% confidence interval [CI]: 1.51-4.25) and 2.56 (95% CI: 1.14-5.75), respectively. The adjusted HR was not significant between the 2 groups (DAA vs. IFN; HR 1.19, 95% CI: 0.61-2.33). CONCLUSIONS: Obesity and heavy alcohol consumption increased the risk of HCC development after SVR.
BACKGROUND AND AIMS: It remains unclear whether obesity increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C who achieved a sustained virological response (SVR) with antiviral therapy. METHODS: In this multicenter cohort study, we enrolled patients with chronic hepatitis C who achieved SVR with interferon (IFN)-based therapy (IFN group) or direct-acting antiviral (DAA) therapy (DAA group) between January 1, 1990, and December 31, 2018. The patients underwent regular surveillance for HCC. Cumulative incidence of and the risk factors for HCC development after SVR were assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis, respectively. RESULTS: Among 2,055 patients (840 in the IFN group and 1,215 in the DAA group), 75 developed HCC (41 in the IFN group and 34 in the DAA group) during the mean observation period of 4.1 years. The incidence rates of HCC at 1, 2, and 3 years were 1.2, 1.9, and 3.0%, respectively. Multivariate analysis revealed that in addition to older age, lower albumin level, lower platelet count, higher alpha-fetoprotein level, and absence of dyslipidemia, obesity (body mass index ≥25 kg/m2) and heavy alcohol consumption (≥60 g/day) were independent risk factors for HCC development, with adjusted hazard ratio (HR) of 2.53 (95% confidence interval [CI]: 1.51-4.25) and 2.56 (95% CI: 1.14-5.75), respectively. The adjusted HR was not significant between the 2 groups (DAA vs. IFN; HR 1.19, 95% CI: 0.61-2.33). CONCLUSIONS: Obesity and heavy alcohol consumption increased the risk of HCC development after SVR.
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Authors: Yucel Aydin; Ali Riza Koksal; Paul Thevenot; Srinivas Chava; Zahra Heidari; Dong Lin; Tyler Sandow; Krzysztof Moroz; Mansour A Parsi; John Scott; Ari Cohen; Srikanta Dash Journal: J Hepatocell Carcinoma Date: 2021-12-08