6533b825fe1ef96bd1282937

RESEARCH PRODUCT

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

Giuseppe CabibboSalvatore PettaMarco BarbaraSimona AttardoLaura BucciFabio FarinatiEdoardo GianniniGiulia NegriniFrancesca CiccareseGian Ludovico RapacciniMaria Di MarcoEugenio CaturelliMarco ZoliFranco BorzioRodolfo SaccoRoberto VirdoneFabio MarraAndrea MegaFilomena MoriscoLuisa Benvegnã¹Antonio GasbarriniGianluca Svegliati BaroniFrancesco Giuseppe FoschiAndrea OlivaniAlberto MasottoGerardo NardoneAntonio ColecchiaMarcello PersicoAntonio Craxã¬Franco Trevisani Cammã  Calogero

subject

Liver CirrhosisMaleHepatocellular Carcinoma Liver Cirrhosis hepatitis C virus Survival direct-acting antiviral agentsSurvival rateCirrhosisAntiviral agentGastroenterologyLiver cirrhosi0302 clinical medicineRecurrenceHepatic decompensation; Hepatitis C Virus (HCV); Hepatocellular carcinoma (HCC); Prognosis; Recurrences; Sustained virological response (SVR); overall survival (OS)Overall survivalLiver NeoplasmsHepatitis Coverall survival (OS)Middle AgedPrognosisHepatitis CSustained virological responseLocal030220 oncology & carcinogenesisHepatocellular carcinoma030211 gastroenterology & hepatologyFemaleAntiviral agents; Carcinoma hepatocellular; Hepatic decompensation; Hepatitis C; Hepatocellular carcinoma (HCC); Liver cirrhosis; Overall survival; Prognosis; Recurrences; Survival rate; Sustained virological response; Aged; Carcinoma Hepatocellular; Female; Hepatitis C; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence Local; Proportional Hazards ModelsLiver cancerHepatic decompensationmedicine.medical_specialtyCarcinoma HepatocellularPrognosiSettore MED/12 - GASTROENTEROLOGIA03 medical and health scienceshepatocellularInternal medicinemedicineEarly Hepatocellular CarcinomaHumansRecurrencesHepatocellular carcinoma (HCC)Survival rateAntiviral agents; Carcinoma hepatocellular; Hepatic decompensation; Hepatitis C; Hepatocellular carcinoma (HCC); Liver cirrhosis; Overall survival; Prognosis; Recurrences; Survival rate; Sustained virological response; HepatologyAgedProportional Hazards ModelsHepatologybusiness.industryHepatitis C Virus (HCV)CarcinomaHepatocellularHepatologymedicine.diseasedigestive system diseasesNeoplasm RecurrenceAntiviral agentsLiver cirrhosisLiver functionNeoplasm Recurrence LocalbusinessSustained virological response (SVR)

description

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.

yearjournalcountryeditionlanguage
2017-01-01
10.1016/j.jhep.2017.01.033http://hdl.handle.net/10807/104806