Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long-term analogue therapy for hepatitis B

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Abstract

Background: Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development. Aims: To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients. Methods: All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied. Results: Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second–line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%. Conclusions: HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.

Original languageEnglish
Pages (from-to)431-439
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume48
Issue number4
DOIs
Publication statusPublished - Aug 1 2018

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Hepatitis B
Hepatocellular Carcinoma
Hepatitis B virus
Therapeutics
Liver Transplantation
Hepatitis B e Antigens
Fibrosis
Survival Rate
Recurrence
Survival
Liver
DNA
Serum
Neoplasms

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{a0fb1a293c304f1bbb01164b6c40d271,
title = "Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long-term analogue therapy for hepatitis B",
abstract = "Background: Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development. Aims: To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients. Methods: All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied. Results: Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84{\%} males, 96{\%} Caucasian, 95{\%} HBeAg-negative, 96{\%} with undetectable HBV DNA, 83{\%} with normal ALT levels, and 92{\%} with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36{\%}). HCC was monofocal in 78{\%}, had a median diameter of 20 (6-57) mm and was in its early stage in 92{\%} which allowed potentially curative treatments in 78{\%} (39{\%} ablation, 28{\%} surgical resection, 11{\%} liver transplantation). Overall, a complete response was obtained in 61 (80{\%}) patients: in 40 after a first-line treatment, in 3 after the second–line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84{\%} from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74{\%}. Conclusions: HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.",
author = "A. Loglio and M. Iavarone and G. Grossi and M. Vigan{\`o} and Rumi, {M. G.} and F. Facchetti and G. Lunghi and A. Sangiovanni and M. Colombo and P. Lampertico",
year = "2018",
month = "8",
day = "1",
doi = "10.1111/apt.14848",
language = "English",
volume = "48",
pages = "431--439",
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TY - JOUR

T1 - Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long-term analogue therapy for hepatitis B

AU - Loglio, A.

AU - Iavarone, M.

AU - Grossi, G.

AU - Viganò, M.

AU - Rumi, M. G.

AU - Facchetti, F.

AU - Lunghi, G.

AU - Sangiovanni, A.

AU - Colombo, M.

AU - Lampertico, P.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development. Aims: To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients. Methods: All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied. Results: Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second–line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%. Conclusions: HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.

AB - Background: Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development. Aims: To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients. Methods: All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied. Results: Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second–line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%. Conclusions: HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.

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U2 - 10.1111/apt.14848

DO - 10.1111/apt.14848

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JO - Alimentary Pharmacology and Therapeutics

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