The impact of background liver disease on the long-term prognosis of very-early-stage HCC after ablation therapy

Kenta Takaura,Masayuki Kurosaki,Hiroyuki Nakanishi,Namiki Izumi,Kouji Yamashita,Yuka Takahashi,Sakura Kirino,Kaoru Tsuchiya,Yutaka Yasui,Nobuharu Tamaki,Shuhei Sekiguchi,Leona Osawa,Kento Inada,Chiaki Maeyashiki,Jun Itakura,Shun Kaneko,Yuka Hayakawa,Masakazu Higuchi ,T Muto

doi:10.1371/journal.pone.0264075

Kenta Takaura, Masayuki Kurosaki + Show 17 more

Open Access

https://doi.org/10.1371/journal.pone.0264075

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Abstract

The long-term prognosis of hepatocellular carcinoma (HCC) treated at a very-early-stage (the Barcelona Clinical Liver Cancer (BCLC) classification stage 0) was unclear, especially in terms of background liver disease. This single-center, retrospective study included 302 patients with BCLC stage 0 HCC treated with radiofrequency ablation (RFA) and followed for at least six months. We examined the impact of background liver disease on overall survival and recurrence. The median age was 72 (range; 36-91) years; the median tumor diameter was 15 (range; 8-20) mm. The etiologies of background liver disease were hepatitis B virus infection (HBV) in 24 cases, hepatitis C virus infection (HCV) in 195 cases, and non-viral (NBNC) in 83 cases. Among the patients with HCV, 63 had achieved sustained virological response (SVR) by antiviral therapy (HCV SVR) before developing HCC (n = 37) or after HCC treatment (n = 26), and 132 had active HCV infection (HCV non-SVR). The median overall survival was 85 (95% CI; 72-98) months, and the median recurrence-free survival was 26 (95% CI; 20-30) months. Active infection with hepatitis C virus negatively contributed to overall survival (HR 2.91, 95% CI 1.31-3.60, p = 0.003) and recurrence-free survival (HR 1.47, 95% CI 1.06-2.05, p = 0.011). The prognosis of RFA treatment for very early-stage HCC was favorable. Achieving SVR in hepatitis C was important for further prognosis improvement.

Highlights

Hepatocellular carcinoma (HCC) remains the fourth leading cause of cancer-related death globally, the second leading cause of death among men, and the sixth leading cause of death among women [1,2]
Active infection with hepatitis C virus negatively contributed to overall survival (HR 2.91, 95% CI 1.31–3.60, p = 0.003) and recurrence-free survival (HR 1.47, 95% CI 1.06–2.05, p = 0.011)
Achieving sustained viral response (SVR) in hepatitis C was important for further prognosis improvement

Summary

Results

The overall survival was compared between patients with active HCV infection during the observation period (HCV non-SVR) and others, including HBV, HCV SVR, and NBNC (Fig 3). In patients with active HCV infection during the observation period (HCV non-SVR), the median recurrence-free survival was 20 (95% CI 15–26) months compared to 31 (95% CI 23– 38) months in the others (p < 0.001). Recurrence-free survival rates at 1, 3, and 5 years was 66.0%, 28.9%, and 16.3%, respectively, in the HCV non-SVR group, versus 77.6%, 41.6%, and 28.2% in the others (Fig 5). The median recurrence-free survival was 29 (95% CI, 18–NA) months in patients who achieved SVR before HCC compared to 41 (95% CI, 29–74) months in those who achieved SVR after RFA treatment for HCC (p = 0.49) (Fig 6B). The impact of the inclusion period of the patients or the effect of post-treatment of the patients seems to be minimal in this study cohort

Conclusions

Introduction

Discussion