Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Genotype III and Advanced Hepatic Fibrosis After Treatment With DAA

Hamna  Waqar; Fatima  Babar; Sher  Nawab; Hira Amran  Chowdhry; Hamza  Irfan; Duaa  Fatima

doi:10.54112/bcsrj.v6i2.1577

Authors

Hamna Waqar Arif Memorial Teaching Hospital Lahore, Pakistan
Fatima Babar Rashid Latif Medical College/Arif Memorial Hospital Lahore, Pakistan
Sher Nawab Arif Memorial Teaching Hospital Lahore, Pakistan
Hira Amran Chowdhry Rashid Latif Medical College/Arif Memorial Hospital Lahore, Pakistan
Hamza Irfan Rashid Latif Medical College/Arif Memorial Hospital Lahore, Pakistan
Duaa Fatima Rashid Latif Medical College/Arif Memorial Hospital Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i2.1577

Keywords:

Hepatocellular carcinoma, Hepatitis C, Fibrosis, Cirrhosis

Abstract

Direct-acting antivirals with high efficacy and safety are effective in the treatment of cirrhotic and fibrosis patients with chronic hepatitis C patients. Objective: We conducted this study to assess the incidence of hepatocellular carcinoma in chronic hepatitis C patients genotype III with hepatic fibrosis or cirrhosis after the achievement of sustained viral response after treatment with direct-acting antivirals. Methods: A prospective study was conducted at the Department of Medicine, Arif Memorial Hospital, Lahore, from October 2023 to October 2024. A total of 500 CHC genotype III patients diagnosed with F3 and F4, who were undergoing treatment with direct-acting antivirals, were included in the study. Patients received a 3-month or 6-month course of DAA regimens. HCC was diagnosed by performing triphasic MSCT, and staging was done. Results: Out of 500 patients, 50 patients were diagnosed with HCC in the follow-up. HCC patients were predominantly elderly and male and had elevated AST, AFP, and bilirubin levels, as well as reduced platelet and albumin levels, compared to non-HCC patients. In cirrhotic patients, the HCC incidence per year was 2.920 per 100 people. Advanced age, male gender, increased AFP, and decreased albumin were among the predictors of HCC incidence in F4 patients. Conclusion: A reduced incidence of HCC was observed in patients with CHC fibrosis and cirrhosis who achieved SVR after treatment with DAAs.

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References

McGlynn KA, Petrick JL, El‐Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology. 2021 Jan; 73:4-13.https://doi.org/10.1002/hep.31288

Yen YH, Cheng YF, Wang JH, Lin CC, Wang CC. Characteristics and etiologies of hepatocellular carcinoma in patients without cirrhosis: When East meets West. Plos one. 2021 Jan 13;16(1):e0244939.https://doi.org/10.1371/journal.pone.0244939

Orci LA, Sanduzzi-Zamparelli M, Caballol B, Sapena V, Colucci N, Torres F, Bruix J, Reig M, Toso C. Incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: a systematic review, meta-analysis, and meta-regression. Clin Gastroenterol Hepatol. 2022 Feb 1;20(2):283-92.https://doi.org/10.1016/j.cgh.2021.05.002

Kinoshita MN, Minami T, Tateishi R, Wake T, Nakagomi R, Fujiwara N, Sato M, Uchino K, Enooku K, Nakagawa H, Asaoka Y. Impact of direct-acting antivirals on early recurrence of HCV-related HCC: Comparison with interferon-based therapy. J Hepatol. 2019 Jan 1;70(1):78-86.https://doi.org/10.1016/j.jhep.2018.09.029

Dang H, Yeo YH, Yasuda S, Huang CF, Iio E, Landis C, Jun DW, Enomoto M, Ogawa E, Tsai PC, Le A. Cure with interferon‐free direct‐acting antiviral is associated with increased survival in patients with hepatitis C virus‐related hepatocellular carcinoma from both east and west. Hepatology. 2020 Jun;71(6):1910-22.https://doi.org/10.1002/hep.30988

Janjua NZ, Wong S, Darvishian M, Butt ZA, Yu A, Binka M, Alvarez M, Woods R, Yoshida EM, Ramji A, Feld J. The impact of SVR from direct‐acting antiviral‐and interferon‐based treatments for HCV on hepatocellular carcinoma risk. Jviral hepat. 2020 Aug;27(8):781-93.https://doi.org/10.1111/jvh.13295

Dash S, Aydin Y, Widmer KE, Nayak L. Hepatocellular carcinoma mechanisms associated with chronic HCV infection and the impact of direct-acting antiviral treatment. J Hepatocell carcinoma. 2020 Apr 15:45-76.DOI: 10.2147/JHC.S221187

Yeh ML, Liang PC, Tsai PC, Wang SC, Leong J, Ogawa E, Jun DW, Tseng CH, Landis C, Tanaka Y, Huang CF. Characteristics and survival outcomes of hepatocellular carcinoma developed after HCV SVR. Cancers. 2021 Jul 9;13(14):3455.https://doi.org/10.3390/cancers13143455

Hsu PY, Liang PC, Huang CI, Hsieh MH, Tsai YS, Lin TC, Yeh ML, Huang CF, Wang CW, Jang TY, Lin YH. Effects of Achieving SVR on Clinical Characteristics and Surgical Outcomes in Patients Who Developed Early-Stage HCV-Related Hepatocellular Carcinoma and Received Curative Resection: Preoperative versus Postoperative SVR. Viruses. 2022 Oct 31;14(11):2412.https://doi.org/10.3390/v14112412

Golfieri R, Bargellini I, Spreafico C, Trevisani F. Patients with Barcelona Clinic Liver Cancer stages B and C hepatocellular carcinoma: time for a subclassification. Liver cancer. 2019 Jun 27;8(2):78-91.https://doi.org/10.1159/000489791

Watanabe T, Tokumoto Y, Joko K, Michitaka K, Horiike N, Tanaka Y, Tada F, Kisaka Y, Nakanishi S, Yamauchi K, Yukimoto A. Predictors of hepatocellular carcinoma occurrence after direct‐acting antiviral therapy in patients with hepatitis C virus infection. Hepatol Res. 2019 Feb;49(2):136-46.https://doi.org/10.1111/hepr.13278

Carrat F, Fontaine H, Dorival C, Simony M, Hezode C, De Ledinghen V, Larrey D, Haour G, Bronowicki JP, Zoulim F, Asselah T. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study.Lancet. 2019 Apr 6;393(10179):1453-64.https://doi.org/10.1016/S0140-6736(18)32111-1

Wei L, Huang YH. Long-term outcomes in patients with chronic hepatitis C in the current era of direct-acting antiviral agents. Expert revanti-infect ther. 2019 May 4;17(5):311-25.https://doi.org/10.1080/14787210.2019.1588112

Ide T, Koga H, Nakano M, Hashimoto S, Yatsuhashi H, Higuchi N, Nakamuta M, Oeda S, Eguchi Y, Shakado S, Sakisaka S. Direct-acting antiviral agents do not increase the incidence of hepatocellular carcinoma development: a prospective, multicenter study. Hepatol int. 2019 May 1;13:293-301.https://doi.org/10.1007/s12072-019-09939-2

Romano A, Angeli P, Piovesan S, Noventa F, Anastassopoulos G, Chemello L, Cavalletto L, Gambato M, Russo FP, Burra P, Vincenzi V. Newly diagnosed hepatocellular carcinoma in patients with advanced hepatitis C treated with DAAs: a prospective population study. J Hepatol. 2018 Aug 1;69(2):345-52.https://doi.org/10.1016/j.jhep.2018.03.009

Li DK, Ren Y, Fierer DS, Rutledge S, Shaikh OS, Re III VL, Simon T, Abou‐Samra AB, Chung RT, Butt AA. The short‐term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct‐acting antivirals: An ERCHIVES study. Hepatology. 2018 Jun 1;67(6):2244-53.DOI: 10.1002/hep.29707

Huang CF, Yeh ML, Huang CI, Liang PC, Lin YH, Lin ZY, Chen SC, Huang JF, Dai CY, Chuang WL, Yu ML. Post-treatment fibrotic modifications overwhelm pretreatment liver fibrosis in predicting HCC in CHC patients with curative antivirals. Hepatol Int. 2018 Nov;12:544-51.https://doi.org/10.1007/s12072-018-9908-4

Sanchez-Azofra M, Vázquez IF, Garcia ML, Dominguez L, Fernandez-Rodriguez C, Bonet L, Montes M, Ryan P, Gea F, Sanchez AD, Garcia-Mayor M. SAT-229-Risk of hepatocellular carcinoma in patients with chronic hepatitis C and stage-3 liver fibrosis after sustained virological response with direct acting antivirals. JHepatol. 2019 Apr 1;70(1):e731.

Lleo A, Aglitti A, Aghemo A, Maisonneuve P, Bruno S, Persico M, Rendina M, Ciancio A, Lampertico P, Brunetto MR, Di Marco V. Predictors of hepatocellular carcinoma in HCV cirrhotic patients treated with direct acting antivirals. Dig Liver Dis. 2019 Feb 1;51(2):310-7.https://doi.org/10.1016/j.dld.2018.10.014

Degasperi E, D’Ambrosio R, Iavarone M, Sangiovanni A, Aghemo A, Soffredini R, Borghi M, Lunghi G, Colombo M, Lampertico P. Factors associated with increased risk of de novo or recurrent hepatocellular carcinoma in patients with cirrhosis treated with direct-acting antivirals for HCV infection. ClinGastroenterolHepatol. 2019 May 1;17(6):1183-91.https://doi.org/10.1016/j.cgh.2018.10.038

Nakano M, Koga H, Ide T, Kuromatsu R, Hashimoto S, Yatsuhashi H, Seike M, Higuchi N, Nakamuta M, Shakado S, Sakisaka S. Predictors of hepatocellular carcinoma recurrence associated with the use of direct‐acting antiviral agent therapy for hepatitis C virus after curative treatment: A prospective multicenter cohort study. Cancer Med. 2019 May;8(5):2646-53.https://doi.org/10.1002/cam4.2061