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

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• 作者：Fabio Conti¹ ; ^&dagger ; ; Federica Buonfiglioli¹ ; ^&dagger ; ; Alessandra Scuteri² ; Cristina Crespi² ; Luigi Bolondi³ ; Paolo Caraceni³ ; Francesco Giuseppe Foschi⁴ ; Marco Lenzi¹ ; Giuseppe Mazzella³ ; Gabriella Verucchi¹ ; Pietro Andreone¹ ; ^&Dagger ; ; Stefano Brillanti¹ ; ^&Dagger ; ; ^{stefano.brillanti@unibo.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HCC ; hepatocellular carcinoma ; DAA ; direct-acting antivirals ; HCV ; hepatitis C virus ; SVR ; sustained virological response ; AIFA ; Italian Medicines Agency ; CEUS ; contrast-enhanced ultrasonography ; CT ; computerized tomography ; MRI ; magnetic resonance imaging ; RFA ; radiofrequency ablation ; TACE ; trans-arterial chemoembolization ; PEI ; percutaneous ethanol injection ; ROC ; receiver operating characteristics ; kPa ; kilo Pascal ; MELD ; model for end stage liver disease ; HBsAg ; hepatitis B surface antigen
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：65
• 期：4
• 页码：727-733
• 全文大小：660 K

文摘

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.