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The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis

The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis
The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis

Background: Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. Aim: To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. Methods: All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. Results: Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165 (87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. Conclusion: There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate.

cirrhosis, hepatitis C, hepatocellular carcinoma, liver, outcomes research
0269-2813
204-214
Mecci, Ali Jibran
3a9783e8-c2f0-4954-82ce-d9cf12c4611e
Kemos, Polychronis
3e30b1de-edfb-4c32-8188-6bf75784e70c
Leen, Clifford
62ee63ff-9514-4c85-9b8c-ea0a641adcf7
Lawson, Adam
eedf6ac8-7dd7-4c22-9497-e2be63770362
Richardson, Paul
8b08e854-841d-419d-86fa-c371b0a9b1a9
Khakoo, Salim I.
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Agarwal, Kosh
318c0cdd-390b-475d-bf02-323f52b75d7e
Mutimer, David
d67a2cc4-f17d-446d-9167-955177f1c982
Rosenberg, William M.
145ebec3-ffb6-45e7-8711-aa520ed42f55
Foster, Graham R.
02706339-bf67-4d05-b1d3-a16c54245008
Irving, William L.
ed6993df-07a9-4cc1-a859-aa616d644f43
on behalf of HCV Research UK
Mecci, Ali Jibran
3a9783e8-c2f0-4954-82ce-d9cf12c4611e
Kemos, Polychronis
3e30b1de-edfb-4c32-8188-6bf75784e70c
Leen, Clifford
62ee63ff-9514-4c85-9b8c-ea0a641adcf7
Lawson, Adam
eedf6ac8-7dd7-4c22-9497-e2be63770362
Richardson, Paul
8b08e854-841d-419d-86fa-c371b0a9b1a9
Khakoo, Salim I.
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Agarwal, Kosh
318c0cdd-390b-475d-bf02-323f52b75d7e
Mutimer, David
d67a2cc4-f17d-446d-9167-955177f1c982
Rosenberg, William M.
145ebec3-ffb6-45e7-8711-aa520ed42f55
Foster, Graham R.
02706339-bf67-4d05-b1d3-a16c54245008
Irving, William L.
ed6993df-07a9-4cc1-a859-aa616d644f43

Mecci, Ali Jibran, Kemos, Polychronis, Leen, Clifford, Lawson, Adam, Richardson, Paul, Khakoo, Salim I., Agarwal, Kosh, Mutimer, David, Rosenberg, William M., Foster, Graham R. and Irving, William L. , on behalf of HCV Research UK (2019) The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis. Alimentary pharmacology & therapeutics, 50 (2), 204-214. (doi:10.1111/apt.15296).

Record type: Article

Abstract

Background: Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. Aim: To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. Methods: All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. Results: Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165 (87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. Conclusion: There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate.

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More information

Accepted/In Press date: 19 April 2019
e-pub ahead of print date: 31 May 2019
Published date: July 2019
Keywords: cirrhosis, hepatitis C, hepatocellular carcinoma, liver, outcomes research

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Local EPrints ID: 433936
URI: http://eprints.soton.ac.uk/id/eprint/433936
ISSN: 0269-2813
PURE UUID: feb812b9-e173-4a24-8b94-c731c9a79d5e

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Date deposited: 06 Sep 2019 16:30
Last modified: 19 Nov 2019 17:31

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Contributors

Author: Ali Jibran Mecci
Author: Polychronis Kemos
Author: Clifford Leen
Author: Adam Lawson
Author: Paul Richardson
Author: Salim I. Khakoo
Author: Kosh Agarwal
Author: David Mutimer
Author: William M. Rosenberg
Author: Graham R. Foster
Author: William L. Irving

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