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Lui FH, Moosvi Z, Patel A, Hussain S, Duong A, Duong J, Nguyen DL. Decreased risk of hepatocellular carcinoma recurrence with direct-acting antivirals compared with no treatment for hepatitis C: a meta-analysis. Ann Gastroenterol 2020; 33:293-298. [PMID: 32382233 PMCID: PMC7196608 DOI: 10.20524/aog.2020.0470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Studies investigating the association between direct-acting antivirals (DAAs) and the recurrence of hepatocellular carcinoma (HCC) related to hepatitis C (HCV) have yielded conflicting results. The objective of this meta-analysis was to define the short- and long-term recurrence rates of HCC after DAA treatment. Methods A search of multiple databases was performed, including Scopus, Cochrane, MEDLINE/PubMed and abstracts from gastroenterology meetings. Only studies reporting the recurrence of HCC in patients receiving DAA treatment, compared to HCV controls without DAA treatment, were evaluated. A meta-analysis was completed using the Mantel-Haenszel model. Results A comprehensive literature search resulted in 32 abstracts and papers. Six papers met our inclusion criteria and were included in the analysis. Follow up ranged from 1.25-4 years. Analysis of these 6 studies found a >60% lower risk of HCC recurrence in patients exposed to DAA compared to controls (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.27-0.47; P<0.001; I2=88%). A sensitivity analysis, which excluded studies showing the lowest recurrence rate to reduce heterogeneity, showed that patients receiving DAA still had a 60% lower risk of developing HCC (OR 0.4, 95%CI 0.26-0.61; P<0.0001; I2=39%) and a 66% lower risk of developing HCC beyond 1 year (OR 0.34, 95%CI 0.22-0.54; P<0.00001; I2=0%) compared to controls. Conclusions The use of DAA is associated with a significantly lower risk of HCC development compared to DAA-untreated patients, both overall and beyond 1 year of treatment. Further studies are needed to assess the impact of DAAs on early recurrence.
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Affiliation(s)
- Felix H Lui
- Department of Gastroenterology and Hepatology (Felix H. Lui, Alex Duong, Jacqueline Duong, Douglas L. Nguyen)
| | - Zain Moosvi
- Department of Internal Medicine (Zain Moosvi, Anish Patel, Samiya Hussain), University of California-Irvine, Orange, CA, USA
| | - Anish Patel
- Department of Internal Medicine (Zain Moosvi, Anish Patel, Samiya Hussain), University of California-Irvine, Orange, CA, USA
| | - Samiya Hussain
- Department of Internal Medicine (Zain Moosvi, Anish Patel, Samiya Hussain), University of California-Irvine, Orange, CA, USA
| | - Alex Duong
- Department of Gastroenterology and Hepatology (Felix H. Lui, Alex Duong, Jacqueline Duong, Douglas L. Nguyen)
| | - Jacqueline Duong
- Department of Gastroenterology and Hepatology (Felix H. Lui, Alex Duong, Jacqueline Duong, Douglas L. Nguyen)
| | - Douglas L Nguyen
- Department of Gastroenterology and Hepatology (Felix H. Lui, Alex Duong, Jacqueline Duong, Douglas L. Nguyen)
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Wang X, Gao F, Yuan G, Shi K, Huang Y, Chen Y, Qiu R, Sun L, Liu J, Hu C, Zhou Y. Ten-year follow-up analysis of chronic hepatitis C patients after getting sustained virological response to pegylated interferon-α and ribavirin therapy. J Viral Hepat 2016; 23:971-976. [PMID: 27453300 DOI: 10.1111/jvh.12574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/07/2016] [Indexed: 01/23/2023]
Abstract
There is little data on the long-term follow-up outcomes of chronic hepatitis C patients achieving sustained virological response (SVR) after treatment with peglylated interferon-α plus ribavirin. We prospectively investigated the overall clinical, biochemical, virological and histological outcomes in a ten-year cohort study of 325 patients with chronic hepatitis C achieving SVR to pegylated interferon-α and ribavirin therapy. Patients underwent consistent clinical, biochemical and virological evaluation every six months, and patients with pretherapy Ishak fibrosis score ≥2 were invited to accept a second liver biopsy at the last follow-up. Liver biopsy specimens were evaluated using Ishak's scoring system. At the end of follow-up, five patients developed decompensated liver cirrhosis. One patient (0.3%) with pretherapy cirrhosis was diagnosed with hepatocellular carcinoma (HCC). A total of 305 patients (94%) had normal serum ALT and AST levels during the entire period of follow-up. Twenty-seven patients (8%) had conclusive evidence of virological relapse. Among the 117 patients with paired pretherapy and long-term follow-up biopsies, 96 (82%) had a decreased fibrosis score. Ninety-nine (79%) had a decrease in combined inflammation score. Thirty-seven (32%) had normal or nearly normal livers on long-term follow-up biopsy. SVR achieved with PEG-IFN-α and RBV combination therapy is durable, while late virological relapse may still occur in some patients. Clinical outcomes for patients who obtain SVR are excellent, although the patients with cirrhosis are still at a low risk of hepatocellular carcinoma.
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Affiliation(s)
- X Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - F Gao
- Department of Infectious Diseases, Linyi People's Hospital, Linyi, Shandong, China
| | - G Yuan
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - K Shi
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Huang
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - R Qiu
- Department of Infectious Diseases, The Affiliated Hospital of Putian University, Putian, Fujian, China
| | - L Sun
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - J Liu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - C Hu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Y Zhou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Seeff LB. Sustained virologic response: is this equivalent to cure of chronic hepatitis C? Hepatology 2013; 57:438-40. [PMID: 22815252 DOI: 10.1002/hep.25964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 02/06/2023]
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Gramenzi A, Conti F, Cammà C, Grieco A, Picciotto A, Furlan C, Romagno D, Costa P, Rendina M, Ancarani F, Chiaramonte M, Verucchi G, Craxì A, Bernardi M, Andreone P. Hepatitis C in the elderly: a multicentre cross-sectional study by the Italian Association for the Study of the Liver. Dig Liver Dis 2012; 44:674-80. [PMID: 22538206 DOI: 10.1016/j.dld.2012.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 02/28/2012] [Accepted: 03/04/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of hepatitis C virus infection increases with advancing age, but elderly hepatitis C virus patients remain an understudied population. AIM To define the virological, epidemiological and clinical profiles of Italian outpatients aged 65 years and over infected by hepatitis C virus. METHODS We evaluated 1544 anti-hepatitis C virus positive patients aged ≥65 years referred to 34 Italian outpatient specialty clinics over a two-year period. RESULTS The study population included 1134 (73%) early elderly (65-74 years) and 410 (27%) late elderly patients (≥75 years). Late elderly subjects were less likely to have their virus genotyped, their viral load assessed or a histological evaluation of liver disease. Overall, 30% of patients had advanced liver disease whose prevalence increased with increasing age. In both age groups, about 40% of patients had normal transaminase levels. Excluding patients with past infection, 51% had not received any antiviral treatment and only 25% were treated after the age of 65. Late elderly patients, women and patients with advanced liver diseases had been less frequently treated. The main reason for exclusion from treatment was age followed by the presence of comorbid conditions. CONCLUSIONS Elderly hepatitis C virus patients referred to Italian specialty clinics have advanced and underestimated liver disease. Nevertheless, they are progressively understudied in parallel with increasing age.
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Affiliation(s)
- Annagiulia Gramenzi
- Department of Clinical Medicine, University of Bologna, Via Massarenti 9, Bologna, Italy
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Kanda T, Imazeki F, Mikami S, Kato K, Shimada N, Yonemitsu Y, Miyauchi T, Arai M, Fujiwara K, Tsubota A, Takada N, Nishino T, Takashi M, Sugiura N, Kimura M, Fukai K, Yokosuka O. Occurrence of hepatocellular carcinoma was not a rare event during and immediately after antiviral treatment in Japanese HCV-positive patients. Oncology 2011; 80:366-72. [PMID: 21822027 DOI: 10.1159/000330549] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/02/2011] [Indexed: 12/12/2022]
Abstract
Advanced chronic hepatitis C patients with sustained virolological response by antivirals remain at risk for hepatocellular carcinoma (HCC). We investigated the incidence of HCC during and immediately after peginterferon-alfa-2a and ribavirin (RBV) treatment in patients with chronic hepatitis C in Japan. HCC was detected in 8 of 238 patients during and after these treatments (mean follow-up period: 572 ± 252 days). In conclusion, occurrence of HCC is not a rare event during and immediately after peginterferon-alfa-2a plus RBV treatment. In cases with cirrhosis, higher α-fetoprotein levels, old age, or a previous history of HCC treatment, clinicians should be especially alert for the possible development of HCC during and immediately after peginterferon-alfa-2a and RBV treatment. Clinicians should regularly check for the possible development of HCC even in chronic hepatitis C patients under treatment.
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Affiliation(s)
- Tatsuo Kanda
- Department of Medicine and Clinical Oncology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
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Takashimizu S, Kojima SI, Nagata J, Nishizaki Y, Kagawa T, Shiraishi K, Mine T, Kaneko JI, Kokudo N, Watanabe N. Intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma developed after a 6-year sustained virological response to interferon therapy for chronic hepatitis C. Clin J Gastroenterol 2011; 4:167-173. [PMID: 26189349 DOI: 10.1007/s12328-011-0216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
A 67-year-old male patient presenting with chronic hepatitis C (CHC) achieved a sustained virological response (SVR) following 6 months of treatment with 6 million units of beta-interferon (IFN). The SVR state continued for 6 years. Hepatocellular carcinoma (HCC) developed in liver segments 4 and 5, and was treated with transcatheter arterial chemoembolization, followed by radiofrequency ablation of the tumors. A recurrence of HCC occurred in segment 4 one and a half years after the initial treatment for HCC and a new tumor also developed in segment 8. These tumors were diagnosed to be recurrent HCC, and the three hepatic segments were resected. The pathological examination and immunostaining of the tumors revealed the tumor in segment 4 to be a well to moderately differentiated typical HCC. On the other hand, the tumor in segment 8 was a moderately to poorly differentiated adenocarcinoma and was diagnosed as an intrahepatic cholangiocellular carcinoma (ICC). HCC developed from CHC in a patient who achieved a 6-year SVR after IFN therapy, followed one and a half years later by the development of a heterochronous ICC at a different site, thus indicating the presence of HCC-ICC double cancer. This was an exceedingly rare and clinically important case in terms of the carcinogenic mechanism of HCC and ICC from a post-SVR CHC patient. We have to be aware of the possible development not only of HCC but of ICC after SVR in CHC patients.
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Affiliation(s)
- Shinji Takashimizu
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Sei-Ichiro Kojima
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Junko Nagata
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Yasuhiro Nishizaki
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Tatehiro Kagawa
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Koichi Shiraishi
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Tetsuya Mine
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan
| | - Jun-Ichi Kaneko
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norihito Watanabe
- Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.
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Derbala M, Amer A. Hepatocellular carcinoma in Hepatitis C genotype 4 after viral clearance and in absence of cirrhosis: two case reports. CASES JOURNAL 2009; 2:7927. [PMID: 20181199 DOI: 10.1186/1757-1626-0002-0000007927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 08/24/2009] [Indexed: 01/16/2023]
Abstract
Genotype 4 Hepatitis C virus represents approximately 20% of global Hepatitis C virus infection and is the source of a considerable burden to health-care providers across the globe. Many studies reported that interferon reduces the risk of hepatocellular carcinoma in patients with chronic hepatitis C.Hereby, we are reporting two cases of hepatocellular carcinoma in Hepatitis C virus-genotype 4 after complete viral eradication and in absence of cirrhosis. We aim to highlight the possible direct oncogenic effect of Hepatitis C virus-genotype 4, particularly with concomitant bilharzial infection and the importance of life-log follow up of these patients even in absence of cirrhosis.
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Affiliation(s)
- Moutaz Derbala
- Department of Gastroenterology & Hepatology, Hamad Medical Corporation, Doha, P.O. Box #3050, Qatar.
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Attallah AM, Shiha GE, Ismail H, Mansy SE, El-Sherbiny R, El-Dosoky I. Expression of p53 protein in liver and sera of patients with liver fibrosis, liver cirrhosis or hepatocellular carcinoma associated with chronic HCV infection. Clin Biochem 2008; 42:455-61. [PMID: 19063876 DOI: 10.1016/j.clinbiochem.2008.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/06/2008] [Accepted: 11/07/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) is a major aetiological agent of chronic hepatitis and it leads to the development of liver cirrhosis and hepatocellular carcinoma (HCC). The significances of p53 protein and anti-p53 antibodies levels in HCV genotype IV infected patients with different liver pathology were evaluated. DESIGN AND METHODS Immunostaining and western blot based on monospecific anti-p53 antibody were used for the identification of p53 protein in liver tissues and serum samples. The serum levels of p53 protein and anti-p53 IgG antibodies were evaluated using enzyme linked immunosorbent assay (ELISA). RESULTS Mild and diffuse p53 cytoplasmic immunostaining was found in liver tissues of patients with liver fibrosis [F1-F3] and liver cirrhosis [F4] in comparison with strong and diffuse p53 cytoplasmic immunostaining in patients with HCC. The target p53 protein was identified in sera of patients with liver fibrosis, liver cirrhosis and HCC at 53-kDa. The detection rate of serum p53 protein increases significantly (p<0.05) with the progression of the liver pathology. However, a significant difference (p<0.05) was only shown between serum p53 protein level of HCC patients and those of other liver pathology. In contrast, anti-p53 IgG antibodies positive rates showed only a significant decrease (p<0.05) in HCC in comparison with liver cirrhosis. CONCLUSIONS The serum and cytoplasmic p53 protein expressions were more pronounced in patients with HCC more than liver cirrhosis, and in liver cirrhosis more than liver fibrosis. These results suggest that HCV genotype IV and p53 protein levels may have a role in the development of HCC among Egyptian patients.
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Affiliation(s)
- Abdelfattah M Attallah
- R & D Department, Biotechnology Research Center, 23 July Street, New Damietta City, Egypt.
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