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Past history of hepatocellular carcinoma is an independent risk factor of treatment failure in patients with chronic hepatitis C virus infection receiving direct‐acting antivirals
Author(s) -
Sugiura Ayumi,
Joshita Satoru,
Umemura Takeji,
Yamazaki Tomoo,
Fujimori Naoyuki,
Kimura Takefumi,
Matsumoto Akihiro,
Igarashi Koji,
Usami Yoko,
Wada Shuichi,
Mori Hiromitsu,
Shibata Soichiro,
Yoshizawa Kaname,
Morita Susumu,
Furuta Kiyoshi,
Kamijo Atsushi,
Iijima Akihiro,
Kako Satoko,
Maruyama Atsushi,
Kobayashi Masakazu,
Komatsu Michiharu,
Matsumura Makiko,
Miyabayashi Chiharu,
Ichijo Tetsuya,
Takeuchi Aki,
Koike Yuriko,
Gibo Yukio,
Tsukadaira Toshihisa,
Inada Hiroyuki,
Kiyosawa Kendo,
Tanaka Eiji
Publication year - 2018
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12973
Subject(s) - hepatocellular carcinoma , medicine , gastroenterology , odds ratio , hepatitis c virus , confidence interval , risk factor , virus , immunology
Summary Direct‐acting antiviral ( DAA ) treatment can achieve a high sustained virological response ( SVR ) rate in patients with hepatitis C virus ( HCV ) infection regardless of a history of hepatocellular carcinoma ( HCC [+]). We examined 838 patients (370 men, median age: 69 years) who were treated with DAA s for comparisons of clinical findings between 79 HCC (+) (9.4%) and 759 HCC (−) (90.6%) patients and associations with treatment outcome. Male frequency was significantly higher in the HCC (+) group (60.8% vs 42.4%, P = 0.006). There were significant differences between the HCC (+) and HCC (−) groups for platelet count (115 vs 152 ×10 9 /L, P < 0.001), baseline alpha fetoprotein ( AFP ) (9.9 vs 4.5 ng/mL, P < 0.001) and the established fibrosis markers of FIB ‐4 index (4.7 vs 3.0, P < 0.001), AST‐to‐platelet ratio index ( APRI ) (1.1 vs 0.7, P = 0.009), M2 BPG i (3.80 vs 1.78 COI , P < 0.001) and autotaxin (1.91 vs 1.50 mg/L, P < 0.001). The overall SVR rate was 94.7% and significantly lower in the HCC (+) group (87.3 vs 95.5%, P = 0.001). Multivariate analysis revealed that a history of HCC was independently associated with DAA treatment failure (odds ratio: 3.56, 95% confidence interval: 1.32‐9.57, P = 0.01). In conclusion, patients with chronic HCV infection and prior HCC tended to exhibit more advanced disease progression at DAA commencement. HCC (+) status at the initiation of DAA s was significantly associated with adverse therapeutic outcomes. DAA treatment for HCV should therefore be started as early as possible, especially before complicating HCC .