Original articlePancreas, biliary tract, and liverFactors Associated With Increased Risk of De Novo or Recurrent Hepatocellular Carcinoma in Patients With Cirrhosis Treated With Direct-Acting Antivirals for HCV Infection
Section snippets
Patient Population
Consecutive HCV patients with cirrhosis starting DAA treatment between December 2014 and 2016 at a single hepatology center were enrolled. Exclusion criteria were Child-Pugh-Turcotte (CPT) C score, whose treatment was not reimbursed by Italian National Health System outside the liver transplant waiting list; human immunodeficiency virus coinfection; and active HCC at baseline (DAA start), whose treatment was not allowed by Italian prescription rules. Patients with baseline atypical or
Baseline Patient Characteristics
This study includes 565 HCV CPT A-B patients with cirrhosis starting DAA between December 2014 and 2016 and followed for a median of 25 (3–39) months after DAA start: 505 patients had no previous HCC history, and 60 patients had a previous HCC (Figure 1). The baseline patient characteristics are shown in Table 1. Overall, median age was 64 (28–87) years, 60% were males, and 87% had CPT score A. Among CPT A patients, 14 (2.4%) had history of previous ascites, occurring 24 (6–48) months before
Discussion
This single-center, longitudinal 3-year follow-up study, including 565 patients with cirrhosis treated with DAAs, reports rates of de novo and recurrent HCC of 2% and 13% per year, respectively. Being most HCC diagnosed in early stages, the majority of patients received curative HCC treatments. Moreover, male gender, diabetes, and liver stiffness or noninvasive markers of liver fibrosis were found to be the strongest and independent predictors of de novo HCC, whereas diabetes was the only
References (24)
- et al.
Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication
J Hepatol
(2017) - et al.
Survival of patients with HCV cirrhosis and sustained virologic response is similar to the general population
J Hepatol
(2016) - et al.
Outcomes after successful direct-acting antiviral therapy for patients with chronic hepatitis C and decompensated cirrhosis
J Hepatol
(2016) - et al.
Newly diagnosed hepatocellular carcinoma in patients with advanced hepatitis C treated with DAAs: a prospective population study
J Hepatol
(2018) - et al.
Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct-acting antivirals
J Hepatol
(2016) - et al.
Unexpected high incidence of hepatocellular carcinoma in cirrhotic patients with sustained virologic response following interferon-free direct-acting antiviral treatment
J Hepatol
(2016) - et al.
High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis
J Hepatol
(2016) - et al.
Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy
J Hepatol
(2016) - et al.
HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma
J Hepatol
(2018) - et al.
Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: a systematic review, meta-analyses, and meta-regression
J Hepatol
(2017)
Transient elastography: a new non-invasive method for assessment of hepatic fibrosis
Ultrasound Med Biol
Incidence of hepatocellular carcinoma in patients with HCV-associated cirrhosis treated with direct-acting antiviral agents
Gastroenterology
Cited by (0)
Conflicts of interest These authors disclose the following: Elisabetta Degasperi received speaking and teaching fees from Gilead, MSD, BMS, and AbbVie. Roberta D’Ambrosio is on the Advisory Board at AbbVie and Gilead; received speaking and teaching fees from AbbVie, Gilead, MSD, and BMS; and received research support from Gilead. Massimo Iavarone received speaking and teaching fees from Bayer, Gilead Science, Janssen, BTG, and AbbVie; and is a consultant at BTG. Angelo Sangiovanni is on the Speaker Bureau at Bayer, Gilead Science, Janssen, BTG, AbbVie, and Novartis; and on the advisory board at Tiziana Life sciences. Alessio Aghemo has received grant and research support from Gilead and Abbvie; is on the Advisory Board at Gilead, MSD, AbbVie, Janssen, BMS, and Alfasigma; and on the Speaker Bureau at Gilead, MSD, AbbVie, Janssen, and BMS. Massimo Colombo has received grant and research support from BMS and Gilead Science; is on advisory committees at Merck, Roche, Novartis, Bayer, BMS, Gilead Science, Tibotec, Vertex, Janssen Cilag, Achillion, Lundbeck, GSK, GenSpera, AbbVie, AlfaWasserman, and Jennerex; and has received speaking and teaching fees from Tibotec, Roche, Novartis, Bayer, BMS, Gilead Science, Vertex, Merck, Janssen, Sanofi, and AbbVie. Pietro Lampertico is on the Speaker Bureau at Bristol-Myers Squibb, Roche, Gilead, GlaxoSmithKline, MSD, and Janssen.
The remaining authors disclose no conflicts.