July 10, 2011

Diabetes may not affect outcomes in hepatocellular carcinoma after radio-frequency ablation

Hepatogastroenterology. 2011 Mar-Apr;58(106):551-7.

Chen WT, Macatula TC, Lin CC, Lin CJ, Lin SM.

Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.


BACKGROUND/AIMS: Diabetes mellitus (DM) is prevalent in patients with hepatocellular carcinoma (HCC) but its effects on post-radiofrequency ablation (RFA) have not been elucidated. This study aims to determine whether DM significantly impacts the outcomes in patients with HCC after RFA.

METHODOLOGY: This retrospective study included 161 HCC patients successfully treated with RFA. Intra-hepatic HCC recurrence and survival were analysed.

RESULTS: No significant difference was found for 1-, 2-, 3- year's intra-hepatic HCC recurrence rates (DM: 45%, 61%, 74% vs. non-DM: 42%, 62%, 75%;p=0.935) and survival rates (DM: 83%, 80%, 73% vs. non-DM: 92%, 84%, 79%; p=0.218) between diabetics (53 patients) and non-diabetics (108 patients). In subgroup analysis of viral etiology and HCC, no significant difference was noted for intra-hepatic HCC recurrence or survival in hepatitis B virus-related or hepatitis C virus-related HCC. Multivariate analysis showed only persistent hepatitis influenced intra-hepatic HCC recurrence (p=0.021) and survival (p=0.022).

CONCLUSION: DM may not affect the intra-hepatic HCC recurrence and survival in patients with HCC after RFA. However, persistent hepatitis after RFA may affect intra-hepatic HCC recurrence and survival.


A sprint to increase response to HCV treatment: expectancies but caution

J Hepatol. 2011 Jun 30. [Epub ahead of print]

Asselah T.

Service d'hépatologie, Hôpital Beaujon, Clichy, France and INSERM, U773, Centre de Recherche Bichat-Beaujon CRB3, and University Paris Diderot.


BACKGROUND: In patients with chronic infection with hepatitis C virus (HCV) genotype 1 who do not have a sustained response to therapy with peginterferon-ribavirin, outcomes after retreatment are suboptimal. Boceprevir, a protease inhibitor that binds to the HCV nonstructural 3 (NS3) active site, has been suggested as an additional treatment.

METHODS: To assess the effect of the combination of boceprevir and peginterferon-ribavirin for retreatment of patients with chronic HCV genotype 1 infection, we randomly assigned patients (in a 1:2:2 ratio) to one of three groups. In all three groups, peginterferon alfa-2b and ribavirin were administered for 4 weeks (the lead-in period). Subsequently, group 1 (control group) received placebo plus peginterferon-ribavirin for 44 weeks; group 2 received boceprevir plus peginterferon-ribavirin for 32 weeks, and patients with a detectable HCV RNA level at week 8 received placebo plus peginterferon-ribavirin for an additional 12 weeks; and group 3 received boceprevir plus peginterferon-ribavirin for 44 weeks.

RESULTS: A total of 403 patients were treated. The rate of sustained virologic response was significantly higher in the two boceprevir groups (group 2, 59%; group 3, 66%) than in the control group (21%, P<0.001). Among patients with an undetectable HCV RNA level at week 8, the rate of sustained virologic response was 86% after 32 weeks of triple therapy and 88% after 44 weeks of triple therapy. Among the 102 patients with a decrease in the HCV RNA level of less than 1 log(10) IU per milliliter at treatment week 4, the rates of sustained virologic response were 0%, 33%, and 34% in groups 1, 2, and 3, respectively. Anemia was significantly more common in the boceprevir groups than in the control group, and erythropoietin was administered in 41 to 46% of boceprevir-treated patients and 21% of controls.

CONCLUSIONS: The addition of boceprevir to peginterferon-ribavirin resulted in significantly higher rates of sustained virologic response in previously treated patients with chronic HCV genotype 1 infection, as compared with peginterferon-ribavirin alone. (Funded by Schering-Plough [now Merck]; HCV RESPOND-2 ClinicalTrials.gov number, NCT00708500).

Copyright © 2011. Published by Elsevier B.V.


Noninvasive tests predicted survival in chronic hepatitis C

Posted on HemOncToday.com July 8, 2011

Vergniol J. Gastroenterology. 2011;140:1970-1979.

Noninvasive tests for fibrosis and liver stiffness predicted 5-year survival in patients with chronic hepatitis C, according to researchers from CHU Bordeaux in France.

“The evaluation of liver fibrosis is a key step to manage a chronic liver disease and to assess its prognosis, as complications mainly occur in patients with advanced stages,” the researchers wrote. “Early assessment of the risk of bad prognosis helps the physician to manage patients with cirrhosis and to make decisions about liver transplantation.”

The researchers prospectively collected data from a cohort of 1,457 consecutive patients who presented with chronic hepatitis C from April 2003 to February 2009. The patients’ fibrosis and liver stiffness were measured using the FibroTest, the aspartate aminotransferase-to-platelet ratio index and the FIB-4. Some patients also received liver biopsies. During the follow-up period, the researchers analyzed data on death, liver-related death and liver transplantation.

At 5 years, the overall survival was 91.7%, and survival without liver-related death was 94.4%. Among patients diagnosed with severe fibrosis at baseline, the survival was significantly decreased. Although all methods used were able to predict shorter survival, liver stiffness and the FibroTest had higher predictive values. After adjustment for treatment response, patient age and estimates of necroinflammatory grade, the prognostic value of liver stiffness (P<.0001) and FibroTest results (P<.0001) remained.

“In this prospective study, we confirmed the prognostic value of liver stiffness and FibroTest on survival,” the researchers wrote. “This information is of major importance, helping us to sharpen our various tools for the follow-up of our patients.”