Past history of hepatocellular carcinoma is an independent risk factor of treatment failure in patients with chronic hepatitis C virus infection receiving direct‐acting antivirals. Issue 12 (30th August 2018)

• Record Type: Journal Article
• Authors: Sugiura, Ayumi; Joshita, Satoru; Umemura, Takeji; Yamazaki, Tomoo; Fujimori, Naoyuki; Kimura, Takefumi; Matsumoto, Akihiro; Igarashi, Koji; Usami, Yoko; Wada, Shuichi; Mori, Hiromitsu; Shibata, Soichiro; Yoshizawa, Kaname; Morita, Susumu; Furuta, Kiyoshi; Kamijo, Atsushi; Iijima, Akihiro; Kako, Satoko; Maruyama, Atsushi; Kobayashi, Masakazu; Komatsu, Michiharu; Matsumura, Makiko; Miyabayashi, Chiharu; Ichijo, Tetsuya; Takeuchi, Aki; Koike, Yuriko; Gibo, Yukio; Tsukadaira, Toshihisa; Inada, Hiroyuki; Kiyosawa, Kendo; Tanaka, Eiji;
• Is Part Of: Journal of viral hepatitis. Volume 25:Issue 12(2018)
• Page Start: 1462
• Page End: 1471
• Publication Date: 2018-08-30
• Subjects: direct‐acting antivirals -- failure -- hepatitis C virus -- hepatocellular carcinoma; Hepatitis, Viral -- Periodicals; Hepatitis, Viral, Animal; Hepatitis, Viral, Human; 616.3623
• DOI: 10.1111/jvh.12973
• Languages: English
• ISSNs: 1352-0504

Abstract

Summary: Direct‐acting antiviral (DAA) treatment can achieve a high sustained virological response (SVR) rate in patients with hepatitis C virus (HCV) infection regardless of a history of hepatocellular carcinoma (HCC [+]). We examined 838 patients (370 men, median age: 69 years) who were treated with DAAs for comparisons of clinical findings between 79 HCC (+) (9.4%) and 759 HCC (−) (90.6%) patients and associations with treatment outcome. Male frequency was significantly higher in the HCC (+) group (60.8% vs 42.4%, P = 0.006). There were significant differences between the HCC (+) and HCC (−) groups for platelet count (115 vs 152 ×10 9 /L, P < 0.001), baseline alpha fetoprotein (AFP) (9.9 vs 4.5 ng/mL, P < 0.001) and the established fibrosis markers of FIB‐4 index (4.7 vs 3.0, P < 0.001), AST‐to‐platelet ratio index (APRI) (1.1 vs 0.7, P = 0.009), M2BPGi (3.80 vs 1.78 COI, P < 0.001) and autotaxin (1.91 vs 1.50 mg/L, P < 0.001). The overall SVR rate was 94.7% and significantly lower in the HCC (+) group (87.3 vs 95.5%, P = 0.001). Multivariate analysis revealed that a history of HCC was independently associated with DAA treatment failure (odds ratio: 3.56, 95% confidence interval: 1.32‐9.57, P = 0.01). In conclusion, patients with chronic HCV infection and prior HCC tended to exhibit more advanced disease progression at DAA commencement. HCC (+) status at the initiation of DAAs was significantly associated with adverse therapeutic outcomes. DAA treatment for HCV should therefore be started as early as possible, especially before complicating HCC.