INCIDENCE OF HEPATOCELLULAR CARCINOMA AND ASSOCIATED RISK FACTORS IN HEPATITIS C-RELATED ADVANCED LIVER DISEASE

By A. Lok, L. Seeff, T. Morgan, A. D. Di Bisceglie, R. Sterling, T. Curto, G. Everson, K. Lindsay, William M. Lee, H. Bonkovsky and 4 more. Gastroenterology, 2008

644 citations recorded by the source corpus.

Background and Aims Although the incidence of hepatocellular carcinoma (HCC) is increasing in the United States, data from large prospective studies are limited. We evaluated the hepatitis C antiviral long-term treatment against cirrhosis (HALT-C) cohort for the incidence of HCC and associated risk factors. Methods HCV-positive patients with bridging fibrosis or cirrhosis that did not respond to peginterferon and ribavirin were randomized to groups that were given maintenance peginterferon for 3.5 years or no treatment. HCC incidence was determined by Kaplan-Meier analysis and baseline factors associated with HCC were analyzed by Cox regression. Results 1,005 patients (mean age 50.2 years, 71% male, 72% white) were studied; 59% had bridging fibrosis and 41% had cirrhosis. During a median follow-up of 4.6 years (maximum 6.7 years), HCC developed in 48 patients (4.8%). The cumulative 5-year HCC incidence was similar for peginterferon-treated patients and controls, 5.4% vs. 5.0% (p=0.78), and was higher among patients with cirrhosis than those with bridging fibrosis, 7.0% vs. 4.1% (p=0.08). HCC developed in eight (17%) patients whose serial biopsies showed only fibrosis. A multivariate analysis model comprising older age, black race, lower platelet count, higher alkaline phosphatase, esophageal varices, and smoking was developed to predict the risk of HCC. Conclusions We found that maintenance peginterferon did not reduce the incidence of HCC in the HALT-C cohort. Baseline clinical and laboratory features predicted risk for HCC. Additional studies are required to confirm our finding of HCC in patients with chronic hepatitis C and bridging fibrosis.

Subfields: Epidemiology, Hepatology

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Citations in the corpus

EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, background): “A recent study from the United States has pointed out that HCC does occur in patients with chronic hepatitis C and bridging fibrosis in the absence of cirrhosis (Metavir F3) [12].”
Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy. (2016, methodology): “Abbreviations: HCV, hepatitis C virus; DAA, direct-acting antivirals; SVR, sustained virological response; MELD, model for end-stage liver disease; HCC, hepatocellular carcinoma; BCLC, Barcelona Clinic Liver Cancer group; LOD, limit of detection; EOT, end of treatment; SVR12, sustained virological r”
Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. (2010, neutral): “1) PVT present 23 (19) 8 (42) 4 (21) 1.”
Hepatocellular carcinoma: a review (2016, background): “In hepatitis C, the development of HCC occurs almost exclusively in the liver with established cirrhosis; however, in the HALT-C trial, 8% of HCC occurred in patients with only advanced fibrosis.(18) Dual infection with HBV and HCV in a cirrhotic patient increases the risk of HCC with an odds ratio ”
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, background): “A recent study from the United States has pointed out that HCC does occur in patients with chronic hepatitis C and bridging fibrosis in the absence of cirrhosis (Metavir F3) [12].”
Management of hepatocellular carcinoma: An update (2011, positive): “developing HCC.(69,70) Based on current knowledge, all patients with hepatitis C and cirrhosis should undergo surveillance.”
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. (2018, background): “Patients with chronic hepatitis C and bridging fibrosis in the absence of cirrhosis (Metavir F3) are also at risk of being understaged and thus at significant risk of HCC.(17) Additionally, the fact that the transition from advanced fibrosis and cirrhosis cannot be accurately defined, led the Europe”
Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma (2010, neutral): “5 years of peginterferon maintenance therapy [100].”