The short-term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct-acting antivirals: An ERCHIVES study

Hepatobiliary Malignancies

Darrick K. Li MD, PhD^1,6, Yanjie Ren MS², Daniel S. Fierer MD³, Stephanie Rutledge MD¹, Obaid S. Shaikh MD², Vincent Lo Re III MD, MSCE⁴, Tracey Simon MD^1,6, Abdul-Badi Abou-Samra MD, PhD^5,7, Raymond T. Chung MD^1,6,* and Adeel A. Butt MD, MS^2,5,7,*

DOI: 10.1002/hep.29707

© 2017 by the American Association for the Study of Liver Diseases.

Hepatology

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Publication History

1. Accepted manuscript online: 2 DEC 2017 11:21AM EST
2. Manuscript Accepted: 20 NOV 2017
3. Manuscript Revised: 12 NOV 2017
4. Manuscript Received: 6 JUL 2017

Keywords: Cirrhosis; sustained virologic response; interferon; sofosbuvir; Veterans

Abstract

Recent studies have reported higher rates of hepatocellular carcinoma (HCC) in individuals treated with direct-acting antivirals (DAAs). However, making definitive conclusions has been challenging due to the heterogeneous populations and methodologies of these reports. We investigated whether DAA use is associated with higher rates of incident HCC compared to treatment with interferon-based regimens. We performed a retrospective population-based cohort study using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database. In a cohort of 17,836 persons, SVR was achieved by 66.6% and 96.2% of the IFN and DAA groups, respectively. Among all treated persons, the risk of HCC was not higher in the DAA group compared to the IFN group (HR 1.07; [95% CI: 0.55, 2.08]). Among persons with cirrhosis who achieved SVR, neither the HCC incidence rate nor HCC-free survival were significantly different in the DAA group compared to the IFN group (21.2 vs. 22.8 per 1000 person years; p=0.78; and log-rank p=0.17, respectively). Untreated persons with cirrhosis had a significantly higher HCC incidence rate (45.3 per 1000 person years) compared to those treated with either IFN or DAAs (p=0.03). Both groups of treated persons had significantly lower probability of HCC development compared to untreated persons (log-rank p=0.0004).

Conclusions: DAA treatment is not associated with a higher risk of HCC in cirrhotics with chronic HCV infection in the short-term. Previously reported higher rates of HCC associated with DAA treatment may be explained by both the presence of relatively fewer baseline HCC risk factors in persons treated with IFN as well as selection bias, as DAA regimens were used to treat persons at higher risk for developing HCC. This article is protected by copyright. All rights reserved.

Source

Nonsurgical options for localized hepatocellular carcinoma

View  issue TOC
Volume 10, Issue 4
October 2017
Pages 103–106

Review

John Ha M.D., Robert J. Wong M.D., M.S.

First published: 31 October 2017

First published: 31 October 2017 Full publication history

DOI: 10.1002/cld.662 View/save citation

Potential conflict of interest: Nothing to report.

Abstract

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths in the United States. With its current trend, HCC is projected to become the third leading cause of cancer-related deaths in the United States by 2030.[1] Currently, more than 55% of HCC cases are diagnosed beyond localized disease, and the majority do not receive definitive curative therapies, such as surgical resection or liver transplantation.[1, 2] Curative therapies are mainly reserved for patients with localized disease or those within Milan criteria. However, many nonsurgical treatment options are still available to patients with unresectable, advanced stage HCC (Table 1). Although there are many options for locoregional or systemic therapies in the management of unresectable HCC, this review will focus specifically on transarterial radioembolization (TARE), radiofrequency (RFA)/microwave ablation (MWA), stereotactic body radiation therapy (SBRT), systemic therapy, and hospice/supportive medicine. It is important to note that the approach for HCC treatment is variable and dependent on many factors, such as medical expertise, performance status, tumor stage and location, and degree of liver dysfunction. Therefore, utilizing multidisciplinary teams may provide the best option for developing a treatment plan.

Table 1. Curative Versus Noncurative Therapies for HCC

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Where I Have Been, and I Am back.

Everyone,

It has been a few years since I have been here to the blog. I went back to school to work on a second BS degree and finally get my MS degree. It did not all work out according to plan though, My health decided to interfere last year so I took some off from school. May 2016 I had my 11 year post  PCR and still SVR. I also had a liver MRI done which showed 3 separate subcentimeter lesions. Let’s move ahead now to December 1st of this year, last Friday, 8 days ago …. I had a follow up MRI which showed early HCC. I have a 1.3cm mass and also a .9mm indeterminate mass. I am in the process of being referred to UNC Chapel Hill. My MRI results and other records are being reviewed there now and I am just waiting to find out who I will be seeing there and for my first appointment to be scheduled.

My plan is to start back posting research on the blog again. It is what I feel I need to get back to doing. All the research I have done over the years has helped me to become the best advocate I can be for myself and to help others.

Well, time to start researching and posting. It is good to be back.

Patricia Emory