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Lam JO, Hurley LB, Lai JB, Saxena V, Seo S, Chamberland S, Quesenberry CP, Champsi JH, Ready J, Chiao EY, Marcus JL, Silverberg MJ. Cancer in People with and without Hepatitis C Virus Infection: Comparison of Risk Before and After Introduction of Direct-Acting Antivirals. Cancer Epidemiol Biomarkers Prev 2021; 30:2188-2196. [PMID: 34583968 PMCID: PMC8667334 DOI: 10.1158/1055-9965.epi-21-0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 09/15/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known. METHODS We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios. RESULTS 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9-34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1-1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2-1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6-2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1-1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1-2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9-36.4) among DAA-untreated and 21.2 (95% CI = 16.8-26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1-2.0) among DAA-untreated and 0.6 (95% CI = 0.3-1.2) among DAA-treated. CONCLUSIONS People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers. IMPACT DAA treatment is important for reducing cancer incidence among people with HCV infection.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Leo B Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jennifer B Lai
- San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael, California
| | - Varun Saxena
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
- University of California San Francisco, San Francisco, California
| | - Suk Seo
- Antioch Medical Center, Kaiser Permanente Northern California, Antioch, California
- Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, California
| | - Scott Chamberland
- Regional Pharmacy, Kaiser Permanente Northern California, Oakland, California
| | | | - Jamila H Champsi
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
| | - Joanna Ready
- Santa Clara Medical Center, Kaiser Permanente Northern California, Santa Clara, California
| | - Elizabeth Y Chiao
- Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Atamla M, Khoury J, Dabbah I, Kramsky R, Yaacob A, Veitsman E, Saadi T. Direct antiviral agents for chronic hepatitis C virus infection improve health-related quality of life significantly in the long term. Clin Exp Hepatol 2021; 7:258-63. [PMID: 34712826 DOI: 10.5114/ceh.2021.109192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Direct antiviral agents (DAAs) are new drugs for the treatment of chronic hepatitis C virus (HCV) infection. These drugs are very effective and well tolerated. HCV can cause liver disease as well as extrahepatic manifestations, including a profound negative impact on health-related quality of life (HRQL). Aim of the study To evaluate HRQL in the long term (> 6 months after finishing treatment) after successful treatment with DAAs. To the best of our knowledge, this is the first study that evaluates quality of life in the long term after DAA treatment. Material and methods This is an observational study which included 100 patients treated with DAAs for chronic HCV infection between January 2015 and August 2018. Patients were assigned randomly. The average time after finishing treatment was 29.96 months. The Liver Disease Symptom Index (LDSI) 2.0 Questionnaire was used to evaluate quality of life before and after treatment. Results Seven of 9 parameters of the LDSI 2.0 Questionnaire showed significant improvement in the long term after successful treatment with DAAs. Two parameters (arthralgia and jaundice) did not improve significantly. Quality of life improved in both males and females similarly. Improvement did not correlate with the severity of liver fibrosis. Conclusions Treatment with DAAs improves HRQL significantly in the long term.
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Khoury J, Nassar G, Kramsky R, Saadi T. Extrahepatic Malignancies After Treatment with Direct Antiviral Agents for Chronic HCV Infection. J Gastrointest Cancer 2020; 51:584-90. [PMID: 31407252 DOI: 10.1007/s12029-019-00293-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Direct antiviral agents (DAAs) have become the treatment of choice for chronic hepatitis C virus (HCV). A safety concern was raised about a possible relationship between DDAs and malignancies. We report unexpected development of extrahepatic malignancies after DAA treatment. METHODS Four hundred thirty-one patients were treated with DAAs in our unit between January 2015 and February 2018. The most common regimen used the combination of paritaprevir/ritonavir/ombitasvir with/without dasabuvir (PrOD) (141 patients, 32.7%). The most common genotype was G1b (317 patients, 73.5%). RESULTS Nine patients (2.08%) were diagnosed with malignancies after treatment: three patients developed lymphoma, one laryngeal carcinoma, one pancreatic adenocarcinoma, one cervix carcinoma, one lung carcinoma, one developed recurrent transitional cell carcinoma of the urinary bladder, and one developed recurrent metastatic breast cancer. The incidence of these malignancies in the cohort was 696 to 100,000 for lymphoma and 232 to 100,000 for each one of the other malignancies described, while the incidence in the general population is 20, 8.8, 1.7, 44.7, 142, and 89.7 to 100,000, respectively. Five of these patients were treated with PrOD, two with sofosbuvir and daclatasvir, one with simeprevir and sofosbuvir, and one with ledipasvir and sofosbuvir. The occurrence of the malignancies was 3 months to 4 years after the end of the treatment. Besides, 10 patients (2.3%) developed HCC and one developed recurrent aggressive HCC. CONCLUSIONS This report raises a question about a possible relationship between treatment with DAAs and development of extrahepatic malignancies. Thus, data collection from larger cohorts is critical to determine the relationship possibility.
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Preda CM, Baicus C, Sandra I, Oproiu A, Manuc T, Constantinescu I, Gavrila D, Diculescu M, Dumitru R, Vasilescu C, Tieranu C, Istratescu D, Voiosu T, Manuc M. Recurrence rate of hepatocellular carcinoma in patients with treated hepatocellular carcinoma and hepatitis C virus-associated cirrhosis after ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin therapy. United European Gastroenterol J 2019; 7:699-708. [PMID: 31210948 DOI: 10.1177/2050640619841254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Recent studies have suggested a higher recurrence rate of hepatocellular carcinoma (HCC) in patients with a history of HCC and hepatitis C virus (HCV)-associated cirrhosis treated with direct-acting antiviral (DAA) agents. Material and methods We conducted a prospective analysis of 24 patients with HCV-associated cirrhosis and treated HCC who received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin for 12 weeks. Prior therapies for HCC included resection (9/24 patients), radiofrequency ablation (RFA) (7/24) and trans-arterial chemoembolization (TACE) (8/24). All patients were eligible for treatment if they had no HCC recurrence 6 months after their last procedure. A control group was defined. All patients were followed every 6 months, with dynamic computed tomography and/or magnetic resonance imaging. Results The sustained virological response rate per protocol was 21/24 (87.5%). The study group included 14 (59%) males, median age 64 years (51-77), 50% with associated non-alcoholic steatohepatitis and 24% with Child-Pugh A6 points. HCC recurrence rate/100 patient-years was lower in the DAA-HCC group versus control: 5.5 versus 24.6% patient-years for the resection+RFA group (p = 0.044), respectively, and 18.6 versus 72.7% patient-years for TACE group (p = 0.002). Survival without recurrence was higher in the resection+RFA group (45 compared to 18 months (p < 0.001)) and also in the TACE group (44 compared to 11.5 months (p = 0.002)). Conclusions DAA therapy significantly reduced the recurrence rate of HCC and improved survival without recurrence in patients with treated HCV-associated HCC.
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Affiliation(s)
- Carmen M Preda
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Cristian Baicus
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Irina Sandra
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Alexandru Oproiu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Teodora Manuc
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ileana Constantinescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Daniel Gavrila
- Surgery Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Mircea Diculescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Radu Dumitru
- Radiology Department, Clinic Fundeni Institute, Bucharest, Romania
| | | | - Cristian Tieranu
- Gastroenterology and Hepatology Department, Elias Emergency Hospital, Bucharest, Romania
| | - Doina Istratescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Theodor Voiosu
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Mircea Manuc
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
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Ravaioli F, Colecchia A, Dajti E, Marasco G, Alemanni LV, Tamè M, Azzaroli F, Brillanti S, Mazzella G, Festi D. Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients. World J Hepatol 2018; 10:731-742. [PMID: 30386466 PMCID: PMC6206152 DOI: 10.4254/wjh.v10.i10.731] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in spleen stiffness measurements (SSMs) and other non-invasive tests (NITs) after treatment with direct-acting antivirals (DAAs) and identify predictors of SSM change after sustained virological response (SVR).
METHODS We retrospectively analysed 146 advanced-chronic liver disease (ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness (LSM), spleen diameter (SD), platelet count (PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 kPa was used as a cut-off to rule-in clinically significant portal hypertension (CSPH). SSM reduction > 20% from baseline was defined as significant.
RESULTS SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.
CONCLUSION SSM and other NITs significantly decrease after SVR, although differently according to the patient’s clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.
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Affiliation(s)
- Federico Ravaioli
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
- Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy
| | - Elton Dajti
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Giovanni Marasco
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Luigina Vanessa Alemanni
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Mariarosa Tamè
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Stefano Brillanti
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Giuseppe Mazzella
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Davide Festi
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
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