Abstract
Background & Aims: The risk of hepatocellular carcinoma (HCC) is reduced but not eradicated among patients with hepatitis C virus (HCV)-induced advanced hepatic fibrosis who attained sustained viral response (SVR). We aimed to assess the risk of cirrhosis-related complications in this specific group of patients. Methods: Data from previously reported Western cohort studies including patients with chronic HCV infection and bridging fibrosis or cirrhosis who attained SVR were pooled for survival analyses on the individual patient level. The primary endpoint was HCC and the secondary endpoint was clinical disease progression, defined as liver failure, HCC or death. Results: Included were 1000 patients with SVR. Median age was 52.7 (IQR 45.1-59.7) years, 676 (68%) were male and 842 (85%) had cirrhosis. Median follow-up was 5.7 (IQR 2.9-8.0) years. Fifty-one patients developed HCC and 101 had clinical disease progression. The cumulative 8-year HCC incidence was 1.8 (95% CI 0.0-4.3) among patients with bridging fibrosis and 8.7% (95% CI 6.0-11.4) among those with cirrhosis (p = 0.058). Within the cirrhosis group, the 8-year HCC incidence was 2.6% (95% CI 0.0-5.5) among patients <45. years, 9.7% (95% CI 5.8-13.6) among patients from 45-60. years, and 12.2% (95% CI 5.3-19.1) among patients >60. years of age at start of therapy (p = 0.006). Multivariable Cox analyses indicated that higher age, lower platelet count and diabetes mellitus were independently associated with development of HCC. After 8. years 4.2% (95% CI 0.1-8.3) of patients with bridging fibrosis and 15.8% (95% CI 12.3-19.3) of patients with cirrhosis experienced clinical disease progression (p = 0.007). Conclusions: Patients with HCV-induced cirrhosis and SVR showed an annual risk of approximately 1% for HCC and 2% for clinical disease progression. Therefore, to prevent HCC surveillance, chronic HCV infection should preferably be treated before cirrhosis has developed. Lay summary: Patients with cirrhosis who were able to eradicate their chronic HCV infection remain at substantial risk of primary liver cancer. The risk of liver cancer increases with higher age, laboratory makers suggesting more severe liver disease, and presence of diabetes mellitus. Also after successful antiviral therapy patients with HCV-induced cirrhosis should thus remain included in follow-up for early detection of liver cancer.
| Original language | English |
|---|---|
| Pages (from-to) | 485-493 |
| Journal | Journal of Hepatology |
| Volume | 66 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2017 |
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Keywords
- Chronic hepatitis C
- Cirrhosis
- Fibrosis
- Hepatocellular carcinoma
- Liver failure
- Survival analysis
- Sustained virological response
ASJC Scopus subject areas
- Hepatology
Cite this
Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication. / van der Meer, Adriaan J.; Feld, Jordan J.; Hofer, Harald; Almasio, Piero L.; Calvaruso, Vincenza; Fernández-Rodríguez, Conrado M.; Aleman, Soo; Ganne-Carrié, Nathalie; D'Ambrosio, Roberta; Pol, Stanislas; Trapero-Marugan, Maria; Maan, Raoel; Moreno-Otero, Ricardo; Mallet, Vincent; Hultcrantz, Rolf; Weiland, Ola; Rutter, Karoline; Di Marco, Vito; Alonso, Sonia; Bruno, Savino; Colombo, Massimo; de Knegt, Robert J.; Veldt, Bart J.; Hansen, Bettina E.; Janssen, Harry L A.
In: Journal of Hepatology, Vol. 66, No. 3, 2017, p. 485-493.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication
AU - van der Meer, Adriaan J.
AU - Feld, Jordan J.
AU - Hofer, Harald
AU - Almasio, Piero L.
AU - Calvaruso, Vincenza
AU - Fernández-Rodríguez, Conrado M.
AU - Aleman, Soo
AU - Ganne-Carrié, Nathalie
AU - D'Ambrosio, Roberta
AU - Pol, Stanislas
AU - Trapero-Marugan, Maria
AU - Maan, Raoel
AU - Moreno-Otero, Ricardo
AU - Mallet, Vincent
AU - Hultcrantz, Rolf
AU - Weiland, Ola
AU - Rutter, Karoline
AU - Di Marco, Vito
AU - Alonso, Sonia
AU - Bruno, Savino
AU - Colombo, Massimo
AU - de Knegt, Robert J.
AU - Veldt, Bart J.
AU - Hansen, Bettina E.
AU - Janssen, Harry L A
PY - 2017
Y1 - 2017
N2 - Background & Aims: The risk of hepatocellular carcinoma (HCC) is reduced but not eradicated among patients with hepatitis C virus (HCV)-induced advanced hepatic fibrosis who attained sustained viral response (SVR). We aimed to assess the risk of cirrhosis-related complications in this specific group of patients. Methods: Data from previously reported Western cohort studies including patients with chronic HCV infection and bridging fibrosis or cirrhosis who attained SVR were pooled for survival analyses on the individual patient level. The primary endpoint was HCC and the secondary endpoint was clinical disease progression, defined as liver failure, HCC or death. Results: Included were 1000 patients with SVR. Median age was 52.7 (IQR 45.1-59.7) years, 676 (68%) were male and 842 (85%) had cirrhosis. Median follow-up was 5.7 (IQR 2.9-8.0) years. Fifty-one patients developed HCC and 101 had clinical disease progression. The cumulative 8-year HCC incidence was 1.8 (95% CI 0.0-4.3) among patients with bridging fibrosis and 8.7% (95% CI 6.0-11.4) among those with cirrhosis (p = 0.058). Within the cirrhosis group, the 8-year HCC incidence was 2.6% (95% CI 0.0-5.5) among patients <45. years, 9.7% (95% CI 5.8-13.6) among patients from 45-60. years, and 12.2% (95% CI 5.3-19.1) among patients >60. years of age at start of therapy (p = 0.006). Multivariable Cox analyses indicated that higher age, lower platelet count and diabetes mellitus were independently associated with development of HCC. After 8. years 4.2% (95% CI 0.1-8.3) of patients with bridging fibrosis and 15.8% (95% CI 12.3-19.3) of patients with cirrhosis experienced clinical disease progression (p = 0.007). Conclusions: Patients with HCV-induced cirrhosis and SVR showed an annual risk of approximately 1% for HCC and 2% for clinical disease progression. Therefore, to prevent HCC surveillance, chronic HCV infection should preferably be treated before cirrhosis has developed. Lay summary: Patients with cirrhosis who were able to eradicate their chronic HCV infection remain at substantial risk of primary liver cancer. The risk of liver cancer increases with higher age, laboratory makers suggesting more severe liver disease, and presence of diabetes mellitus. Also after successful antiviral therapy patients with HCV-induced cirrhosis should thus remain included in follow-up for early detection of liver cancer.
AB - Background & Aims: The risk of hepatocellular carcinoma (HCC) is reduced but not eradicated among patients with hepatitis C virus (HCV)-induced advanced hepatic fibrosis who attained sustained viral response (SVR). We aimed to assess the risk of cirrhosis-related complications in this specific group of patients. Methods: Data from previously reported Western cohort studies including patients with chronic HCV infection and bridging fibrosis or cirrhosis who attained SVR were pooled for survival analyses on the individual patient level. The primary endpoint was HCC and the secondary endpoint was clinical disease progression, defined as liver failure, HCC or death. Results: Included were 1000 patients with SVR. Median age was 52.7 (IQR 45.1-59.7) years, 676 (68%) were male and 842 (85%) had cirrhosis. Median follow-up was 5.7 (IQR 2.9-8.0) years. Fifty-one patients developed HCC and 101 had clinical disease progression. The cumulative 8-year HCC incidence was 1.8 (95% CI 0.0-4.3) among patients with bridging fibrosis and 8.7% (95% CI 6.0-11.4) among those with cirrhosis (p = 0.058). Within the cirrhosis group, the 8-year HCC incidence was 2.6% (95% CI 0.0-5.5) among patients <45. years, 9.7% (95% CI 5.8-13.6) among patients from 45-60. years, and 12.2% (95% CI 5.3-19.1) among patients >60. years of age at start of therapy (p = 0.006). Multivariable Cox analyses indicated that higher age, lower platelet count and diabetes mellitus were independently associated with development of HCC. After 8. years 4.2% (95% CI 0.1-8.3) of patients with bridging fibrosis and 15.8% (95% CI 12.3-19.3) of patients with cirrhosis experienced clinical disease progression (p = 0.007). Conclusions: Patients with HCV-induced cirrhosis and SVR showed an annual risk of approximately 1% for HCC and 2% for clinical disease progression. Therefore, to prevent HCC surveillance, chronic HCV infection should preferably be treated before cirrhosis has developed. Lay summary: Patients with cirrhosis who were able to eradicate their chronic HCV infection remain at substantial risk of primary liver cancer. The risk of liver cancer increases with higher age, laboratory makers suggesting more severe liver disease, and presence of diabetes mellitus. Also after successful antiviral therapy patients with HCV-induced cirrhosis should thus remain included in follow-up for early detection of liver cancer.
KW - Chronic hepatitis C
KW - Cirrhosis
KW - Fibrosis
KW - Hepatocellular carcinoma
KW - Liver failure
KW - Survival analysis
KW - Sustained virological response
UR - http://www.scopus.com/inward/record.url?scp=85006942581&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85006942581&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2016.10.017
DO - 10.1016/j.jhep.2016.10.017
M3 - Article
VL - 66
SP - 485
EP - 493
JO - Journal of Hepatology
JF - Journal of Hepatology
SN - 0168-8278
IS - 3
ER -