Regional Differences in Clinical Presentation and Prognosis of Patients With Post-Sustained Virologic Response Hepatocellular Carcinoma.

Hepatitis C Virus Infection Hepatocellular Carcinoma Prognosis Surveillance Sustained Virologic Response

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
11 Jul 2023
Historique:
received: 08 05 2023
revised: 05 06 2023
accepted: 29 06 2023
pubmed: 14 7 2023
medline: 14 7 2023
entrez: 13 7 2023
Statut: aheadofprint

Résumé

Widespread use of direct-acting antivirals for hepatitis C virus infection has been paralleled with increased numbers of patients with hepatocellular carcinoma (HCC) after achieving sustained virologic response (post-SVR HCC) worldwide. Few data compare regional differences in the presentation and prognosis of patients with post-SVR HCC. We identified patients with advanced fibrosis (F3/F4) who developed incident post-SVR HCC between March 2015 and October 2021 from 30 sites in Europe, North America, South America, the Middle East, South Asia, East Asia, and Southeast Asia. We compared patient demographics, liver dysfunction, and tumor burden by region. We compared overall survival by region using Kaplan-Meier analysis and identified factors associated with survival using multivariable Cox regression analysis. Among 8796 patients with advanced fibrosis or cirrhosis who achieved SVR, 583 (6.6%) developed incident HCC. There was marked regional variation in the proportion of patients detected by surveillance (range: 59.5%-100%), median maximum tumor diameter (range, 1.8-5.0 cm), and the proportion with multinodular HCC (range, 15.4%-60.8%). The prognosis of patients highly varied by region (hazard ratio range, 1.82-9.92), with the highest survival rates in East Asia, North America, and South America, and the lowest survival rates in the Middle East and South Asia. After adjusting for geographic region, HCC surveillance was associated with early stage detection (Barcelona Clinic Liver Cancer stage 0/A, 71.0% vs 21.3%; P < .0001) and lower mortality rates (adjusted hazard ratio, 0.29; 95% CI, 0.18-0.46). Clinical characteristics, including early stage detection, and prognosis of post-SVR HCC differed significantly across geographic regions. Surveillance utilization appears to be a high-yield intervention target to improve prognosis among patients with post-SVR HCC globally.

Sections du résumé

BACKGROUND & AIMS OBJECTIVE
Widespread use of direct-acting antivirals for hepatitis C virus infection has been paralleled with increased numbers of patients with hepatocellular carcinoma (HCC) after achieving sustained virologic response (post-SVR HCC) worldwide. Few data compare regional differences in the presentation and prognosis of patients with post-SVR HCC.
METHODS METHODS
We identified patients with advanced fibrosis (F3/F4) who developed incident post-SVR HCC between March 2015 and October 2021 from 30 sites in Europe, North America, South America, the Middle East, South Asia, East Asia, and Southeast Asia. We compared patient demographics, liver dysfunction, and tumor burden by region. We compared overall survival by region using Kaplan-Meier analysis and identified factors associated with survival using multivariable Cox regression analysis.
RESULTS RESULTS
Among 8796 patients with advanced fibrosis or cirrhosis who achieved SVR, 583 (6.6%) developed incident HCC. There was marked regional variation in the proportion of patients detected by surveillance (range: 59.5%-100%), median maximum tumor diameter (range, 1.8-5.0 cm), and the proportion with multinodular HCC (range, 15.4%-60.8%). The prognosis of patients highly varied by region (hazard ratio range, 1.82-9.92), with the highest survival rates in East Asia, North America, and South America, and the lowest survival rates in the Middle East and South Asia. After adjusting for geographic region, HCC surveillance was associated with early stage detection (Barcelona Clinic Liver Cancer stage 0/A, 71.0% vs 21.3%; P < .0001) and lower mortality rates (adjusted hazard ratio, 0.29; 95% CI, 0.18-0.46).
CONCLUSIONS CONCLUSIONS
Clinical characteristics, including early stage detection, and prognosis of post-SVR HCC differed significantly across geographic regions. Surveillance utilization appears to be a high-yield intervention target to improve prognosis among patients with post-SVR HCC globally.

Identifiants

DOI: 10.1016/j.cgh.2023.06.026 PMID: 37442316
pubmed: 37442316
pii: S1542-3565(23)00534-7
doi: 10.1016/j.cgh.2023.06.026
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Hidenori Toyoda (H)

Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. Electronic address: hmtoyoda@spice.ocn.ne.jp.

Mounika Kanneganti (M)

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

Jonathan Melendez-Torres (J)

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

Neehar D Parikh (ND)

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

Prasun K Jalal (PK)

Division of Abdominal Transplantation, Department of Medicine, Baylor College of Medicine, Houston, Texas.

Federico Piñero (F)

Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.

Manuel Mendizabal (M)

Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.

Ezequiel Ridruejo (E)

Centro de Educación Medica e Investigaciones Clinicas, Norberto Quirno, Buenos Aires, Argentina.

Hugo Cheinquer (H)

Gastroenterology and Hepatology Division, Universidad de Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Andrea Casadei-Gardini (A)

Department of Medical Oncology, Vita-Salute San Raffaele University, Milan, Italy.

Arndt Weinmann (A)

Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

Markus Peck-Radosavljevic (M)

Innere Medizin und Gastroenterologie, Klinikum Klagenfurt am Worthersee, Klagenfurt, Austria.

Jean-Francois Dufour (JF)

Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland.

Pompilia Radu (P)

Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland.

Gamal Shiha (G)

Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egyptian Liver Research Institute and Hospital, El Mansoura, Egypt.

Riham Soliman (R)

Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt.

Shiv K Sarin (SK)

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Manoj Kumar (M)

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Jing-Houng Wang (JH)

Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Pisit Tangkijvanich (P)

Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Wattana Sukeepaisarnjaroen (W)

Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Masanori Atsukawa (M)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.

Haruki Uojima (H)

Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.

Akito Nozaki (A)

Gastroenterology Center, Yokohama City University Medical Center, Yokohama, Japan.

Makoto Nakamuta (M)

Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

Koichi Takaguchi (K)

Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.

Atsushi Hiraoka (A)

Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.

Hiroshi Abe (H)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shinmatusdo Central General Hospital, Matsudo, Japan.

Kentaro Matsuura (K)

Department of Gastroenterology and Metabolism, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.

Tsunamasa Watanabe (T)

Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Noritomo Shimada (N)

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Otakanomori Hospital, Kashiwa, Japan.

Kunihiko Tsuji (K)

Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.

Toru Ishikawa (T)

Department of Hepatology, Saiseikai Niigata Hospital, Niigata, Japan.

Shigeru Mikami (S)

Division of Gastroenterology, Department of Internal Medicine, Kikkoman General Hospital, Noda, Japan.

Ei Itobayashi (E)

Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.

Amit G Singal (AG)

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

Philip J Johnson (PJ)

Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.

Classifications MeSH