TY - JOUR
T1 - Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma
AU - Cabibbo, Giuseppe
AU - Petta, Salvatore
AU - Barbara, Marco
AU - Attardo, Simona
AU - Bucci, Laura
AU - Farinati, Fabio
AU - Giannini, Edoardo G.
AU - Negrini, Giulia
AU - Ciccarese, Francesca
AU - Rapaccini, Gian Lodovico
AU - De Marco, Maria
AU - Caturelli, Eugenio
AU - Zoli, Marco
AU - Borzio, Franco
AU - Sacco, Rodolfo
AU - Virdone, Roberto
AU - Marra, Fabio
AU - Mega, Andrea
AU - Morisco, Filomena
AU - Benvegnù, Luisa
AU - Gasbarrini, Antonio
AU - Svegliati Baroni, Gianluca
AU - Foschi, Francesco Giuseppe
AU - Olivani, Andrea
AU - Masotto, Alberto
AU - Nardone, Gerardo
AU - Colecchia, Antonio
AU - Persico, Marcello
AU - Craxì, Antonio
AU - Trevisani, Franco
AU - Cammà, Calogero
AU - Italian Liver Cancer (ITA.LI.CA) group
PY - 2017/7/1
Y1 - 2017/7/1
N2 - 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.
AB - 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.
KW - Antiviral agents
KW - Carcinoma, hepatocellular
KW - Hepatic decompensation
KW - Hepatitis C
KW - Hepatocellular carcinoma (HCC)
KW - Liver cirrhosis
KW - Overall survival
KW - Prognosis
KW - Recurrences
KW - Survival rate
KW - Sustained virological response
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U2 - 10.1016/j.jhep.2017.01.033
DO - 10.1016/j.jhep.2017.01.033
M3 - Article
AN - SCOPUS:85015722099
SN - 0168-8278
VL - 67
SP - 65
EP - 71
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 1
ER -