Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma

Giuseppe Cabibbo, Salvatore Petta, Marco Barbara, Simona Attardo, Laura Bucci, Fabio Farinati, Edoardo G. Giannini, Giulia Negrini, Francesca Ciccarese, Gian Lodovico Rapaccini, Maria De Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Rodolfo Sacco, Roberto Virdone, Fabio Marra, Andrea Mega, Filomena Morisco, Luisa BenvegnùAntonio Gasbarrini, Gianluca Svegliati Baroni, Francesco Giuseppe Foschi, Andrea Olivani, Alberto Masotto, Gerardo Nardone, Antonio Colecchia, Marcello Persico, Antonio Craxì, Franco Trevisani, Calogero Cammà, Italian Liver Cancer (ITA.LI.CA) group

Research output: Contribution to journalArticle

Abstract

Background & Aims Assessment of long-term outcome is required in hepatitis C virus (HCV)-infected patients with cirrhosis, who have been successfully treated for Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC). However, problems arise due to the lack of models accounting for early changes during follow-up. The aim of this study was to estimate the impact of early events (HCC recurrence or hepatic decompensation within 12 months of complete radiological response) on 5-year overall survival (OS) in a large cohort of patients with HCV and cirrhosis, successfully treated HCC. Methods A total of 328 consecutive Caucasian patients with HCV-related cirrhosis and BCLC stage 0/A HCC who had complete radiological response after curative resection or thermal ablation were prospectively recruited to this study. Primary endpoint of the study was 5-year OS. Independent baseline and time-dependent predictors of 5-year OS were identified by Cox model. Results The observed 5-year survival rate was 44%. The observed HCC early recurrence and early hepatic decompensation rate were 21% and 10%, respectively. Early hepatic decompensation (Hazard Ratio [HR] 7.52; 95% confidence intervals (CI): 1.23–13.48) and HCC early recurrence as time-dependent covariates (HR 2.50; 95%CI: 1.23–5.05), presence of esophageal varices at baseline (HR 1.66; 95% CI: 1.02–2.70) and age (HR 1.04; 95% CI: 1.02–1.07) were significantly associated with the 5-year OS. Conclusion Survival in HCV-infected patients with cirrhosis and successfully treated HCC is influenced by early hepatic decompensation. Our study indirectly suggests that direct-acting antiviral agents could improve OS of HCC patients through long-term preservation of liver function, resulting in a lower cirrhosis-related mortality and a greater change of receiving curative treatments. Lay summary Survival in hepatitis C virus (HCV) infected patients with cirrhosis and successfully treated hepatocellular carcinoma (HCC), is mainly influenced by early hepatic decompensation. HCV eradication after treatment with new direct-acting antiviral agents could improve overall survival of HCC patients through long-term preservation of liver function.

Original languageEnglish
Pages (from-to)65-71
Number of pages7
JournalJournal of Hepatology
Volume67
Issue number1
DOIs
Publication statusPublished - Jul 1 2017

Keywords

  • Antiviral agents
  • Carcinoma, hepatocellular
  • Hepatic decompensation
  • Hepatitis C
  • Hepatocellular carcinoma (HCC)
  • Liver cirrhosis
  • Overall survival
  • Prognosis
  • Recurrences
  • Survival rate
  • Sustained virological response

ASJC Scopus subject areas

  • Hepatology

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    Cabibbo, G., Petta, S., Barbara, M., Attardo, S., Bucci, L., Farinati, F., Giannini, E. G., Negrini, G., Ciccarese, F., Rapaccini, G. L., De Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Virdone, R., Marra, F., Mega, A., Morisco, F., ... Italian Liver Cancer (ITA.LI.CA) group (2017). Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma. Journal of Hepatology, 67(1), 65-71. https://doi.org/10.1016/j.jhep.2017.01.033