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Long‐term outcome of hepatocellular carcinoma occurrence, esophageal varices exacerbation, and mortality in hepatitis C virus‐related liver cirrhosis after interferon‐based therapy
Author(s) -
Ogasawara Nobuhiko,
Saitoh Satoshi,
Akuta Norio,
Fujiyama Shunichiro,
Kawamura Yusuke,
Sezaki Hitomi,
Hosaka Tetsuya,
Kobayashi Masahiro,
Suzuki Fumitaka,
Suzuki Yoshiyuki,
Arase Yasuji,
Ikeda Kenji,
Kumada Hiromitsu
Publication year - 2019
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13418
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , cirrhosis , exacerbation , esophageal varices , hepatitis c virus , hepatitis c , decompensation , portal hypertension , immunology , virus
Aim The long‐term effects of sustained virologic response (SVR) to antiviral therapy on the risk of liver complications, such as exacerbation of esophageal varices (EV), hepatocellular carcinoma (HCC), malignant lymphoma, and liver‐related and overall death in hepatitis C virus (HCV)‐infected patients with liver cirrhosis are not fully known. Methods These risks were evaluated during long‐term follow up of 457 patients with HCV‐related Child–Pugh Class A liver cirrhosis without history of HCC. Results The respective cumulative 5‐ and 10‐year rates of EV exacerbation were 2.0% and 3.1%. Multivariate analysis identified the presence of EVs, thrombocytopenia at baseline. and alcohol intake as significant independent predictors of EV exacerbation before and after SVR. The cumulative 5‐ and 10‐year rates of HCC were 6.8% and 10.2%, respectively. Male sex and the presence of EV were significant independent determinants of HCC before and after SVR. Although the cumulative 5‐year HCC recurrence rate was 49.4%, the overall survival rate since HCC was 73.6% at 5 years. The overall survival rates since SVR were 98.7% and 93.6% at 5 and 10 years, respectively. Progression of HCC was the most frequent all‐cause mortality, but none of the patients died of liver decompensation. Male sex and Fibrosis‐4 index of ≥3.0 after SVR were significant and independent predictors of mortality. Conclusion Patients with HCV remain at risk of HCC for >10 years after achieving SVR, and HCC is the most common cause of mortality. We recommend long‐term surveillance of cirrhotic patients with HCV, even after achieving SVR.