Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus-related cirrhosis who attained sustained virological response

Savino Bruno, Vito Di Marco, Massimo Iavarone, Luigi Roffi, Vincenzo Boccaccio, Andrea Crosignani, Giuseppe Cabibbo, Sonia Rossi, Vincenza Calvaruso, Alessio Aghemo, Luca Giacomelli, Antonio Craxì, Massimo Colombo, Patrick Maisonneuve

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Few studies examined the outcome of patients with hepatitis C virus (HCV)-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer vs end-stage liver disease (ESLD) and the benefit of HCV eradication remain undefined. This multicentre, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumour recurrence in compensated HCC patients treated with interferon (IFN) according to HCV status since HCC diagnosis. Methods: Two groups of patients with HCV-related cirrhosis and HCC were followed since HCC diagnosis: (i) compensated cirrhotics with prior sustained virological response (SVR) on IFN-based regimens (N=19); (ii) compensated cirrhotics without SVR (viraemic) (N=156). RESULTS: Over a median follow-up of 3.0 years since the onset of HCC, OS was longer for HCC patients with SVR than for viraemic patients (log-rank P=.004). The 5-year OS rate was 65.9% in patients with SVR vs 31.9% in viraemic patients. Similar trends were reported for hepatic decompensation (log-rank P=.01) and tumour recurrence (log-rank P=.01). These findings were confirmed at multivariable and propensity score analysis. At propensity analysis, 0/19 compensated patients with SVR died for ESLD vs 7/19 (37%) viraemic patients (P=.004). HCC mortality was similar in the two groups. Conclusions: Hepatocellular carcinoma patients with prior SVR and compensated cirrhosis at the time of tumour diagnosis have prolonged OS than viraemic patients. Given the lack of cirrhosis progression, no SVR patient ultimately died for ESLD while this condition appears the main cause of death among viraemic patients.

Original languageEnglish
Pages (from-to)1526-1534
JournalLiver International
Volume37
Issue number10
DOIs
Publication statusPublished - 2017

Fingerprint

Hepacivirus
Hepatocellular Carcinoma
Fibrosis
Survival
End Stage Liver Disease
Interferons
Neoplasms
Survival Rate
Recurrence
Propensity Score
Cause of Death
Outcome Assessment (Health Care)
Weights and Measures

Keywords

  • Hepatitis C virus
  • Hepatocellular carcinoma
  • Interferon
  • Survival
  • Sustained virological response

ASJC Scopus subject areas

  • Hepatology

Cite this

Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus-related cirrhosis who attained sustained virological response. / Bruno, Savino; Di Marco, Vito; Iavarone, Massimo; Roffi, Luigi; Boccaccio, Vincenzo; Crosignani, Andrea; Cabibbo, Giuseppe; Rossi, Sonia; Calvaruso, Vincenza; Aghemo, Alessio; Giacomelli, Luca; Craxì, Antonio; Colombo, Massimo; Maisonneuve, Patrick.

In: Liver International, Vol. 37, No. 10, 2017, p. 1526-1534.

Research output: Contribution to journalArticle

Bruno, Savino ; Di Marco, Vito ; Iavarone, Massimo ; Roffi, Luigi ; Boccaccio, Vincenzo ; Crosignani, Andrea ; Cabibbo, Giuseppe ; Rossi, Sonia ; Calvaruso, Vincenza ; Aghemo, Alessio ; Giacomelli, Luca ; Craxì, Antonio ; Colombo, Massimo ; Maisonneuve, Patrick. / Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus-related cirrhosis who attained sustained virological response. In: Liver International. 2017 ; Vol. 37, No. 10. pp. 1526-1534.
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abstract = "Background: Few studies examined the outcome of patients with hepatitis C virus (HCV)-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer vs end-stage liver disease (ESLD) and the benefit of HCV eradication remain undefined. This multicentre, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumour recurrence in compensated HCC patients treated with interferon (IFN) according to HCV status since HCC diagnosis. Methods: Two groups of patients with HCV-related cirrhosis and HCC were followed since HCC diagnosis: (i) compensated cirrhotics with prior sustained virological response (SVR) on IFN-based regimens (N=19); (ii) compensated cirrhotics without SVR (viraemic) (N=156). RESULTS: Over a median follow-up of 3.0 years since the onset of HCC, OS was longer for HCC patients with SVR than for viraemic patients (log-rank P=.004). The 5-year OS rate was 65.9{\%} in patients with SVR vs 31.9{\%} in viraemic patients. Similar trends were reported for hepatic decompensation (log-rank P=.01) and tumour recurrence (log-rank P=.01). These findings were confirmed at multivariable and propensity score analysis. At propensity analysis, 0/19 compensated patients with SVR died for ESLD vs 7/19 (37{\%}) viraemic patients (P=.004). HCC mortality was similar in the two groups. Conclusions: Hepatocellular carcinoma patients with prior SVR and compensated cirrhosis at the time of tumour diagnosis have prolonged OS than viraemic patients. Given the lack of cirrhosis progression, no SVR patient ultimately died for ESLD while this condition appears the main cause of death among viraemic patients.",
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T1 - Improved survival of patients with hepatocellular carcinoma and compensated hepatitis C virus-related cirrhosis who attained sustained virological response

AU - Bruno, Savino

AU - Di Marco, Vito

AU - Iavarone, Massimo

AU - Roffi, Luigi

AU - Boccaccio, Vincenzo

AU - Crosignani, Andrea

AU - Cabibbo, Giuseppe

AU - Rossi, Sonia

AU - Calvaruso, Vincenza

AU - Aghemo, Alessio

AU - Giacomelli, Luca

AU - Craxì, Antonio

AU - Colombo, Massimo

AU - Maisonneuve, Patrick

PY - 2017

Y1 - 2017

N2 - Background: Few studies examined the outcome of patients with hepatitis C virus (HCV)-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer vs end-stage liver disease (ESLD) and the benefit of HCV eradication remain undefined. This multicentre, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumour recurrence in compensated HCC patients treated with interferon (IFN) according to HCV status since HCC diagnosis. Methods: Two groups of patients with HCV-related cirrhosis and HCC were followed since HCC diagnosis: (i) compensated cirrhotics with prior sustained virological response (SVR) on IFN-based regimens (N=19); (ii) compensated cirrhotics without SVR (viraemic) (N=156). RESULTS: Over a median follow-up of 3.0 years since the onset of HCC, OS was longer for HCC patients with SVR than for viraemic patients (log-rank P=.004). The 5-year OS rate was 65.9% in patients with SVR vs 31.9% in viraemic patients. Similar trends were reported for hepatic decompensation (log-rank P=.01) and tumour recurrence (log-rank P=.01). These findings were confirmed at multivariable and propensity score analysis. At propensity analysis, 0/19 compensated patients with SVR died for ESLD vs 7/19 (37%) viraemic patients (P=.004). HCC mortality was similar in the two groups. Conclusions: Hepatocellular carcinoma patients with prior SVR and compensated cirrhosis at the time of tumour diagnosis have prolonged OS than viraemic patients. Given the lack of cirrhosis progression, no SVR patient ultimately died for ESLD while this condition appears the main cause of death among viraemic patients.

AB - Background: Few studies examined the outcome of patients with hepatitis C virus (HCV)-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer vs end-stage liver disease (ESLD) and the benefit of HCV eradication remain undefined. This multicentre, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumour recurrence in compensated HCC patients treated with interferon (IFN) according to HCV status since HCC diagnosis. Methods: Two groups of patients with HCV-related cirrhosis and HCC were followed since HCC diagnosis: (i) compensated cirrhotics with prior sustained virological response (SVR) on IFN-based regimens (N=19); (ii) compensated cirrhotics without SVR (viraemic) (N=156). RESULTS: Over a median follow-up of 3.0 years since the onset of HCC, OS was longer for HCC patients with SVR than for viraemic patients (log-rank P=.004). The 5-year OS rate was 65.9% in patients with SVR vs 31.9% in viraemic patients. Similar trends were reported for hepatic decompensation (log-rank P=.01) and tumour recurrence (log-rank P=.01). These findings were confirmed at multivariable and propensity score analysis. At propensity analysis, 0/19 compensated patients with SVR died for ESLD vs 7/19 (37%) viraemic patients (P=.004). HCC mortality was similar in the two groups. Conclusions: Hepatocellular carcinoma patients with prior SVR and compensated cirrhosis at the time of tumour diagnosis have prolonged OS than viraemic patients. Given the lack of cirrhosis progression, no SVR patient ultimately died for ESLD while this condition appears the main cause of death among viraemic patients.

KW - Hepatitis C virus

KW - Hepatocellular carcinoma

KW - Interferon

KW - Survival

KW - Sustained virological response

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U2 - 10.1111/liv.13452

DO - 10.1111/liv.13452

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