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Abstract Details
Title: Hepatitis C virus cure before hepatocellular carcinoma diagnosis is associated with improved survival
J Viral Hepat. 2021 Jan 22. doi: 10.1111/jvh.13475. Online ahead of print.
Ian Lockart12, Behzad Hajarizadeh3, Maryam Alavi3, Scott Davison45, Emilia Prakoso46, Miriam T Levy45, Jacob George7, Gregory J Dore23, Mark Danta12
Author information
1St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
2St Vincent's Hospital, Sydney, New South Wales, Australia.
3The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
4Liverpool Hospital, Sydney, New South Wales, Australia.
5South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
6Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
7Storr Liver Centre, Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Sydney, New South Wales, Australia.
Abstract
Background and aims: The impact of hepatitis C virus (HCV) cure on survival in patients with HCV-related hepatocellular carcinoma (HCC) has been examined, although many studies have been subject to survivor treatment selection bias. We assessed the impact of HCV cure before HCC diagnosis on overall survival.
Methods: Patients with HCV-related HCC at three referral hospitals in Australia were included retrospectively (January 2008 to December 2019). The risk of death following HCC diagnosis among patients who achieved HCV cure before HCC diagnosis, was compared to patients who were viraemic at diagnosis.
Results: Among 422 patients with HCV-related HCC, 101 (24%) achieved HCV cure before HCC diagnosis, 37 with interferon (IFN) and 64 with direct-acting antiviral (DAA) therapy. Patients with HCV cure were more likely to have no cirrhosis or Child-Pugh A liver disease (83% versus 66%, p=0.002), surveillance detection (71% versus 48%, p<0.001), HCC stage O or A (64% versus 45%, p<0.001), and receive curative initial HCC management (51% versus 28%, p<0.001), compared to patients who were viraemic at diagnosis. The 5-year overall survival was 51% in the HCV cure group and 22% in the viraemic group. In adjusted analysis, risk of death was lower in patients with HCV cure before HCC diagnosis compared to patients who were viraemic at diagnosis (adjusted hazard ratio: 0.63; 95% CI: 0.44-0.91; p=0.013).
Conclusions: Patients with HCV-related HCC who have achieved HCV cure before HCC diagnosis have improved overall survival compared to patients who were viraemic at diagnosis.