Abstract
Simple SummaryIt is important to understand the impact of viremia on the survival of hepatocellular carcinoma (HCC) in hepatitis C patients. This study aimed to investigate the characteristics and survival between hepatitis C patients with and without viremia at HCC diagnosis. We enrolled 1,389 HCC patients, including 301 with HCC developed after hepatitis C eradication (post-SVR HCC) and 1,088 with hepatitis C viremia (viremic HCC). Post-SVR HCC patients had better liver function, earlier tumor stages and higher median survival than viremic HCC patients. But post-SVR HCC was not independently associated with survival on further multivariate analysis. On sub-analysis, viremic HCC patients who subsequently eradicated hepatitis C had higher median survival and was also significantly associated with lower mortality as compared to post-SVR HCC. Therefore, the advantages in clinical and tumor characters determined the better overall survival of post-SVR HCC patients; however, eradication of hepatitis C after HCC also improved survival.The clinical presentation and survival of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication as compared to HCC in viremic patients are not well characterized. We aimed to investigate the characteristics and survival between HCV patients with and without viremia at HCC diagnosis.: We retrospectively analyzed overall survival outcomes in 1389 HCV-related HCC patients, including 301 with HCC developed after HCV eradication (post-SVR HCC) and 1088 with HCV viremia at HCC diagnosis (viremic HCC). We also evaluated overall survival in the two groups using propensity score-matching methods.: At HCC diagnosis, post-SVR HCC patients were older, less obese, less likely cirrhotic, with better liver function, lower alfa-fetoprotein levels, earlier BCLC stages, and higher rate of treatment with surgery. Overall, post-SVR HCC patients had higher median survival than viremic patients (153.3 vs. 55.6 months, p < 0.01), but post-SVR HCC was not independently associated with survival on multivariate analysis (adjusted HR: 1.05, 95% CI: 0.76–1.47). However, on sub-analysis, viremic HCC patients who subsequently received anti-viral treatment and achieved SVR had higher median survival than post-SVR HCC patients (p < 0.01). Viremic HCC with subsequent SVR was also significantly associated with lower mortality as compared to post-SVR HCC (adjusted HR: 0.18, 95% CI: 0.11–0.29). In addition, we observed similar findings in our analysis of the propensity score-matched cohorts.: The advantages in clinical and tumor characters at HCC diagnosis determined the better overall survival of post-SVR HCC patients; however, HCV eradication after HCC development was also associated with improved survival.
Highlights
Hepatitis C virus (HCV) infection is a major cause of hepatocellular carcinoma (HCC)globally [1,2]
On sub analysis of the viremic HCC group, we found significant differences in survival rates among the groups with the highest median survival in the viremic HCC with subsequent SVR group, followed by post-SVR HCC patients, and the lowest among those who remained viremic (p < 0.01). (Figure 3A) In addition, the survival differences remained significant in subgroup analysis by the BCLC stage with the viremic HCC with the subsequent SVR group having the highest survival (p < 0.01 for all BCLC stages). (Figure 3B–D)
We found no significant survival difference between the two groups, (Figure S1A) and there was no significance between the two groups in their association to survival on multivariable Cox regression analysis. (Table S4) viremic HCC with subsequent SVR was again associated with improved survival compared to post-SVR HCC. (Table S5) Lastly, we performed a second propensity score matching (PSM) to match the viremic HCC with subsequent SVR and the post-SVR HCC patients by liver cirrhosis, impaired liver status, AST, ALT, creatinine, AFP, BCLC stage 0/A, curative therapy, and HCC diagnosis year yielding 80 pairs of patients with comparable characteristics. (Table S6)
Summary
Hepatitis C virus (HCV) infection is a major cause of hepatocellular carcinoma (HCC)globally [1,2]. Recent data have shown that HCV-HCC patients treated with DAA have higher survival than untreated patients [11], but it is not clear if there are differences in patient and tumor characteristics as well as survival outcomes of patients who developed HCC while viremic versus those who developed HCC after SVR by DAA or IFN-based therapies. We aimed to evaluate a large and diverse cohort of HCVHCC patients to characterize and compare the clinical presentation and long-term survival of HCV-HCC patients by the presence of HCV viremia at HCC diagnosis For those who were still viremic at the time of HCC diagnosis, we evaluated and compared the subgroup who subsequently underwent antiviral therapy and achieved SVR versus those who remained viremic
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
