Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication

Vincenza Calvaruso, Pier Luigi Almasio, Vito Di Marco, Roberta D'Ambrosio, Massimo Colombo, Karoline Rutter, Adriaan J. Van Der Meer, Ola Weiland, Stanislas Pol, Soo Aleman, Raoel Maan, Harry L.A. Janssen, Bart J. Veldt, Robert J. De Knegt, Jordan J. Feld, Conrado M. Fernández-Rodríguez, Nathalie Ganne-Carrié, Rolf Hultcrantz, Vincent Mallet, Ricardo Moreno-OteroHarald Hofer, Savino Bruno, Sonia Alonso, Bettina E. Hansen, Maria Trapero-Marugan

Risultato della ricerca: Articlepeer review

172 Citazioni (Scopus)

Abstract

Background & Aims: The risk of hepatocellular carcinoma (HCC)is reduced but not eradicated among patients with hepatitis Cvirus (HCV)-induced advanced hepatic fibrosis who attained sustained viral response (SVR). We aimed to assess the risk ofcirrhosis-related complications in this specific group of patients.Methods: Data from previously reported Western cohort studiesincluding 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 wasHCC and the secondary endpoint was clinical disease progression,defined as liver failure, HCC or death.Results: Included were 1000 patients with SVR. Median age was52.7 (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 diseaseprogression. 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 thecirrhosis group, the 8-year HCC incidence was 2.6% (95% CI0.0–5.5) among patients <45 years, 9.7% (95% CI 5.8–13.6) amongpatients from 45–60 years, and 12.2% (95% CI 5.3–19.1) amongpatients >60 years of age at start of therapy (p = 0.006).Multivariable Cox analyses indicated that higher age, lower plateletcount and diabetes mellitus were independently associated withdevelopment of HCC. After 8 years 4.2% (95% CI 0.1–8.3) of patientswith bridging fibrosis and 15.8% (95% CI 12.3–19.3) of patients withcirrhosis experienced clinical disease progression (p = 0.007).Conclusions: Patients with HCV-induced cirrhosis and SVRshowed an annual risk of approximately 1% for HCC and 2% forclinical disease progression. Therefore, to prevent HCC surveillance, chronic HCV infection should preferably be treated beforecirrhosis has developed.Lay summary: Patients with cirrhosis who were able to eradicatetheir chronic HCV infection remain at substantial risk of primaryliver cancer. The risk of liver cancer increases with higher age,laboratory makers suggesting more severe liver disease, andpresence of diabetes mellitus. Also after successful antiviral therapy patients with HCV-induced cirrhosis should thus remainincluded in follow-up for early detection of liver cancer. 2016 European Association for the Study of the Liver. Publishedby Elsevier B.V. All rights reserved
Lingua originaleEnglish
pagine (da-a)485-493
Numero di pagine9
RivistaJournal of Hepatology
Volume66
Stato di pubblicazionePublished - 2017

All Science Journal Classification (ASJC) codes

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