INCIDENCE OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC HEPATITIS C GENOTYPE III AND ADVANCED HEPATIC FIBROSIS AFTER TREATMENT WITH DIRECT-ACTING ANTIVIRALS

S KANJU; UK SHERWANI; A RAZA; S SARWAR; MA WADHAK

doi:10.54112/bcsrj.v2024i1.711

Authors

S KANJU Gastroenterology, NMU & H Multan, Pakistan
UK SHERWANI Gastroenterology, MMDC/Ibn-e-Siena Hospital Multan, Pakistan
A RAZA Gastroenterology, NMU & H Multan, Pakistan
S SARWAR Gastroenterology, Azra Naheed Medical College/ Superior University Lahore, Pakistan
MA WADHAK Gastroenterology, NMU & H Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.711

Keywords:

Hepatocellular carcinoma, Hepatitis C, Fibrosis, Cirrhosis

Abstract

A prospective study was conducted at the Gastroenterology Department of Nishtar Hospital from August 2020 to August 2022 to evaluate the incidence of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients with hepatic fibrosis or cirrhosis, genotype III, who achieved sustained viral response (SVR) after treatment with direct-acting antivirals (DAAs). The study included a total of 500 genotype III patients diagnosed with F3 and F4, who received a 3-month or 6-month course of DAA regimens. HCC was diagnosed by performing triphasic MSCT, and staging was done. During the follow-up, 50 out of 500 patients were diagnosed with HCC. The patients diagnosed with HCC were primarily elderly males and had higher levels of AST, AFP, and bilirubin, as well as reduced platelets and albumin levels compared to non-HCC patients. In cirrhotic patients, the incidence of HCC 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. The study findings suggest that CHC patients with fibrosis and cirrhosis who achieve SVR after treatment with DAAs have a reduced incidence of HCC.

Downloads

Download data is not yet available.

References

Carrat, F., Fontaine, H., Dorival, C., Simony, M., Hezode, C., De Ledinghen, V., Larrey, D., Haour, G., Bronowicki, J.-P., and Zoulim, F. (2019). Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. The Lancet 393, 1453-1464.

Dang, H., Yeo, Y. H., Yasuda, S., Huang, C. F., Iio, E., Landis, C., Jun, D. W., Enomoto, M., Ogawa, E., and Tsai, P. C. (2020). 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 71, 1910-1922.

Dash, S., Aydin, Y., Widmer, K. E., and Nayak, L. (2020). Hepatocellular carcinoma mechanisms associated with chronic HCV infection and the impact of direct-acting antiviral treatment. Journal of hepatocellular carcinoma, 45-76.

Degasperi, E., D’Ambrosio, R., Iavarone, M., Sangiovanni, A., Aghemo, A., Soffredini, R., Borghi, M., Lunghi, G., Colombo, M., and Lampertico, P. (2019). Factors associated with increased risk of de novo or recurrent hepatocellular carcinoma in patients with cirrhosis treated with direct-acting antivirals for HCV infection. Clinical Gastroenterology and Hepatology 17, 1183-1191. e7.

Golfieri, R., Bargellini, I., Spreafico, C., and Trevisani, F. (2019). Patients with Barcelona Clinic Liver Cancer stages B and C hepatocellular carcinoma: time for a subclassification. Liver cancer 8, 78-91.

Hsu, P.-Y., Liang, P.-C., Huang, C.-I., Hsieh, M.-H., Tsai, Y.-S., Lin, T.-C., Yeh, M.-L., Huang, C.-F., Wang, C.-W., and Jang, T.-Y. (2022). 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 14, 2412.

Huang, C.-F., Yeh, M.-L., Huang, C.-I., Liang, P.-C., Lin, Y.-H., Lin, Z.-Y., Chen, S.-C., Huang, J.-F., Dai, C.-Y., and Chuang, W.-L. (2018). Post-treatment fibrotic modifications overwhelm pretreatment liver fibrosis in predicting HCC in CHC patients with curative antivirals. Hepatology International 12, 544-551.

Ide, T., Koga, H., Nakano, M., Hashimoto, S., Yatsuhashi, H., Higuchi, N., Nakamuta, M., Oeda, S., Eguchi, Y., and Shakado, S. (2019). Direct-acting antiviral agents do not increase the incidence of hepatocellular carcinoma development: a prospective, multicenter study. Hepatology international 13, 293-301.

Janjua, N. Z., Wong, S., Darvishian, M., Butt, Z. A., Yu, A., Binka, M., Alvarez, M., Woods, R., Yoshida, E. M., and Ramji, A. (2020). The impact of SVR from direct‐acting antiviral‐and interferon‐based treatments for HCV on hepatocellular carcinoma risk. Journal of viral hepatitis 27, 781-793.

Kinoshita, M. N., Minami, T., Tateishi, R., Wake, T., Nakagomi, R., Fujiwara, N., Sato, M., Uchino, K., Enooku, K., and Nakagawa, H. (2019). Impact of direct-acting antivirals on early recurrence of HCV-related HCC: Comparison with interferon-based therapy. Journal of hepatology 70, 78-86.

Li, D. K., Ren, Y., Fierer, D. S., Rutledge, S., Shaikh, O. S., Re III, V. L., Simon, T., Abou‐Samra, A. B., Chung, R. T., and Butt, A. A. (2018). The short‐term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct‐acting antivirals: An ERCHIVES study. Hepatology 67, 2244-2253.

Lleo, A., Aglitti, A., Aghemo, A., Maisonneuve, P., Bruno, S., Persico, M., Rendina, M., Ciancio, A., Lampertico, P., and Brunetto, M. R. (2019). Predictors of hepatocellular carcinoma in HCV cirrhotic patients treated with direct acting antivirals. Digestive and Liver Disease 51, 310-317.

McGlynn, K. A., Petrick, J. L., and El‐Serag, H. B. (2021). Epidemiology of hepatocellular carcinoma. Hepatology 73, 4-13.

Nakano, M., Koga, H., Ide, T., Kuromatsu, R., Hashimoto, S., Yatsuhashi, H., Seike, M., Higuchi, N., Nakamuta, M., and Shakado, S. (2019). 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 Medicine 8, 2646-2653.

Orci, L. A., Sanduzzi-Zamparelli, M., Caballol, B., Sapena, V., Colucci, N., Torres, F., Bruix, J., Reig, M., and Toso, C. (2022). Incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: a systematic review, meta-analysis, and meta-regression. Clinical Gastroenterology and Hepatology 20, 283-292. e10.

Romano, A., Angeli, P., Piovesan, S., Noventa, F., Anastassopoulos, G., Chemello, L., Cavalletto, L., Gambato, M., Russo, F. P., and Burra, P. (2018). Newly diagnosed hepatocellular carcinoma in patients with advanced hepatitis C treated with DAAs: a prospective population study. Journal of hepatology 69, 345-352.

Sanchez-Azofra, M., Vázquez, I. F., Garcia, M. L., Dominguez, L., Fernandez-Rodriguez, C., Bonet, L., Montes, M., Ryan, P., Gea, F., and Sanchez, A. D. (2019). 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. Journal of Hepatology 70, e731.

Watanabe, T., Tokumoto, Y., Joko, K., Michitaka, K., Horiike, N., Tanaka, Y., Tada, F., Kisaka, Y., Nakanishi, S., and Yamauchi, K. (2019). Predictors of hepatocellular carcinoma occurrence after direct‐acting antiviral therapy in patients with hepatitis C virus infection. Hepatology Research 49, 136-146.

Wei, L., and Huang, Y.-H. (2019). Long-term outcomes in patients with chronic hepatitis C in the current era of direct-acting antiviral agents. Expert review of anti-infective therapy 17, 311-325.

Yeh, M.-L., Liang, P.-C., Tsai, P.-C., Wang, S.-C., Leong, J., Ogawa, E., Jun, D. W., Tseng, C.-H., Landis, C., and Tanaka, Y. (2021). Characteristics and survival outcomes of hepatocellular carcinoma developed after HCV SVR. Cancers 13, 3455.

Yen, Y.-H., Cheng, Y.-F., Wang, J.-H., Lin, C.-C., and Wang, C.-C. (2021). Characteristics and etiologies of hepatocellular carcinoma in patients without cirrhosis: When East meets West. Plos one 16, e0244939.