Open AccessDevelopment of Hepatocellular Carcinoma in Patients Aged 75–84 Years With Chronic Hepatitis C Treated With Direct-Acting Antivirals
Author(s) -
Eiichi Ogawa,
Hideyuki Nomura,
Makoto Nakamuta,
Norihiro Furusyo,
Eiji Kajiwara,
Kazufumi Dohmen,
Akira Kawano,
Aritsune Ooho,
Koichi Azuma,
Kazuhiro Takahashi,
Takeaki Satoh,
Toshimasa Koyanagi,
Yasunori Ichiki,
Masami Kuniyoshi,
Kimihiko Yanagita,
Hiromasa Amagase,
Chie Morita,
Rie Sugimoto,
Masaki Kato,
Shinji Shimoda,
Jun Hayashi
Publication year - 2020
Publication title -
the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.69
H-Index - 252
eISSN - 1537-6613
pISSN - 0022-1899
DOI - 10.1093/infdis/jiaa359
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , propensity score matching , cirrhosis , gastroenterology , cumulative incidence , incidence (geometry) , hepatitis c , hepatitis c virus , cohort , confidence interval , immunology , virus , physics , optics
Background Direct-acting antiviral (DAA) treatment has revolutionized hepatitis C virus (HCV) care. We aimed to evaluate the risk for the development of hepatocellular carcinoma (HCC) in patients aged 75–84 years with chronic hepatitis C after HCV elimination. Methods This multicenter cohort study included 2405 consecutive patients with chronic hepatitis C without a history of HCC who achieved HCV elimination by DAAs. Patients in whom HCC developed within 1 year of DAA initiation were excluded. Propensity score matching analysis was used to evaluate differences in HCC risk between patients aged 75–84 versus 60–74 years. Results The median observational period was 3.5 years. Among patients aged 75–84 years with a high Fibrosis-4 (FIB-4) index (≥3.25 at baseline), there was no significant difference in the annual incidence of HCCs between groups with an FIB-4 index ≥3.25 (2.75 per 100 person-years [PY]) versus <3.25 (2.16 per 100 PY) at 12 weeks after the end of treatment, unlike the results in those aged 60–74 years (3.61 and 1.51 per 100 PY, respectively) (adjusted hazard ratio, 2.20; P = .04). In 495 pairs matched by propensity score matching, in patients without cirrhosis, the cumulative HCC incidence was significantly higher in the 75–84-year than in the 60–74-year age group (P = .04). Conclusions Older patients aged 75–84 years remained at high risk for the development of HCC, even after HCV elimination and the improvement of the FIB-4 index to <3.25.