Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct-acting antivirals

JOURNAL OF HEPATOLOGY

卷:65

Article

Conti, Fabio¹  Buonfiglioli, Federica¹  Scuteri, Alessandra²  Crespi, Cristina²  Bolondi, Luigi³  Caraceni, Paolo³  Foschi, Francesco Giuseppe⁴  Lenzi, Marco¹  Mazzella, Giuseppe³  Verucchi, Gabriella¹  Andreone, Pietro¹  Brillanti, Stefano¹ 

[1] Univ Bologna, Dept Med & Surg Sci DIMEC, Res Ctr Study Hepatitis, I-40126 Bologna, Italy

[2] St Orsola Marcello Malpighi Hosp, Dept Digest Dis, Bologna, Italy

[3] Univ Bologna, Dept Med & Surg Sci DIMEC, I-40126 Bologna, Italy

[4] Osped Faenza, Div Internal Med, Faenza, Italy

关键词: Hepatitis C;    Hepatitis C virus;    Direct-Acting antivirals;    Interferon-free therapy;    Cirrhosis;    Sustained virological response;    Hepatocellular carcinoma;    HCC recurrence;    HCC occurrence;    HCC development;    HCC prevention;    Cancer immunosurveillance;   

DOI  :  10.1016/j.jhep.2016.06.015

来源: Elsevier

【 摘 要 】

Background & Aims: Hepatocellular carcinoma (HCC) represents a serious complication of HCV-related cirrhosis. New direct acting antivirals (DAA) cure HCV infection in over 90% of patients. The aim of this study was to evaluate the early occurrence and recurrence of HCC in cirrhotic patients treated with DAA. Methods: We analysed 344 consecutive cirrhotic patients, without HCC, who were treated with DAA, and followed for 24 weeks. Fifty-nine patients had previous HCC. Results: DAA therapy induced sustained virological response in 91% of patients. During 24-week follow-up, HCC was detected in 26 patients (7.6%, 95% CI: 4.99-10.84): 17 of 59 patients (28.81%, 95% CI: 17.76-42.07) with previous HCC and 9 of 285 patients (3.16%, 95% CI: 1.45-5.90) without previous HCC. Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development, at univariate analysis. At multivariate analysis, Child-Pugh class (p = 0.03, OR: 4.18, 95% CI: 1.17-14.8) and history of HCC (p <0.0001, OR: 12.0, 95% CI: 4.02-35.74) resulted independently associated with HCC development. Among the 59 patients with previous HCC, younger age and more severe liver fibrosis were significantly associated with HCC recurrence, both at univariate and at multivariate analysis. Conclusions: In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce occurrence of HCC, and patients previously treated for HCC have still a high risk of tumour recurrence, in the short term. For these reasons, all cirrhotic patients should be closely monitored and followed during and after antiviral therapy. Lay summary: New direct-acting antivirals are able to eradicate HCV infection in over 90% of patients with advanced liver disease. Unfortunately, the occurrence of liver cancer is not reduced in effectively treated cirrhotic patients. In addition, patients previously treated for HCC have still a high risk of tumour recurrence in the short term, despite DAA treatment. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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