The risk of hepatocellular carcinoma in cirrhotic patients with hepatitis C and sustained viral response: Role of the treatment regimen

JOURNAL OF HEPATOLOGY

卷:68

Article

Innes, Hamish^1,2  Barclay, Stephen T.³  Hayes, Peter C.⁴  Fraser, Andrew⁵  Dillon, John F.⁶  Stanley, Adrian³  Bathgate, Andy⁴  McDonald, Scott A.^1,2  Goldberg, David^1,2  Valerio, Heather^1,2  Fox, Ray⁷  Kennedy, Nick⁸  Bramley, Pete⁹  Hutchinson, Sharon J.^1,2 

[1] Glasgow Caledonian Univ, Sch Hlth & Life Sci, Glasgow, Lanark, Scotland

[2] Hlth Protect Scotland, Glasgow, Lanark, Scotland

[3] Glasgow Royal Infirm, Glasgow, Lanark, Scotland

[4] Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland

[5] Aberdeen Royal Infirm, Aberdeen, Scotland

[6] Ninewells Hosp & Med Sch, Dundee, Scotland

[7] Brownlee Ctr, Glasgow, Lanark, Scotland

[8] Monklands Hosp, Airdrie, Lanark, Scotland

[9] Stirling Royal Infirm, Stirling, Scotland

关键词: Hepatocellular carcinoma;    Interferon-free therapy;    Direct acting antivirals;    Sustained viral response;    Cirrhosis;   

DOI  :  10.1016/j.jhep.2017.10.033

来源: Elsevier

【 摘 要 】

Background & Aims: Previous studies have reported a high frequency of hepatocellular carcinoma (HCC) occurrence in patients with advanced liver disease, after receipt of interferon (IFN)-free therapy for hepatitis C virus (HCV) infection. Our objective was to verify and account for this phenomenon using data from the Scottish HCV clinical database. Methods: We identified HCC-naive individuals with liver cirrhosis receiving a course of antiviral therapy in Scotland from 1997-2016 resulting in a sustained virologic response. Patients were followed-up from their treatment start date to the earliest of: date of death, date of HCC occurrence, or 31 January 2017. We used Cox regression to compare the risk of HCC occurrence according to treatment regimen after adjusting for relevant cofactors (including: demographic factors; baseline liver disease stage; comorbidities/health behaviours, virology, and previous treatment experience). HCC occurrence was ascertained through both the HCV clinical database and medical chart review. For our main analysis, treatment regimen was defined as IFN-free vs. IFN-containing. Results: A total of 857 patients met the study criteria, of whom 31.7% received an IFN-free regimen. Individuals receiving IFN-free therapy were more likely to be: older; of white ethnicity, Child-Turcotte-Pugh B/C vs. Child-Turcotte-Pugh A; thrombocytopenic; non-genotype 3; and treatment experienced. HCC occurrence was observed in 46 individuals during follow-up. In univariate analysis, IFN-free therapy was associated with a significantly increased risk of HCC (HR: 2.48; p = 0.021). However, after multivariate adjustment for baseline factors, no significant risk attributable to IFN-free therapy persisted (aHR: 1.15, p = 0.744). Conclusion: These findings suggest that the higher incidence of HCC following sustained virologic response with IFN-free therapy relates to baseline risk factors/patient selection, and not the use of IFN-free therapy per se. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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