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Llovet JM, Pavel M, Rimola J, Diaz MA, Colmenero J, Saavedra-Perez D, Fondevila C, Ayuso C, Fuster J, Ginès P, Bruix J, Garcia-Valdecasas JC. Pilot study of living donor liver transplantation for patients with hepatocellular carcinoma exceeding Milan Criteria (Barcelona Clinic Liver Cancer extended criteria). Liver Transpl 2018; 24:369-379. [PMID: 29140601 DOI: 10.1002/lt.24977] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/15/2022]
Abstract
A subset of patients with hepatocellular carcinoma (HCC) beyond Milan criteria might obtain acceptable survival outcomes after liver transplantation. Living donor liver transplantation (LDLT) has emerged as a feasible alternative to overcome the paucity of donors. In 2001, we started a protocol for LDLT in Child A-B patients with HCC fulfilling a set of criteria-the Barcelona Clinic Liver Cancer (BCLC) expanded criteria-that expanded the conventional indications of transplantation: 1 tumor ≤ 7 cm, 5 tumors ≤ 3 cm, and 3 tumors ≤ 5 cm without macrovascular invasion or downstaging to Milan after locoregional therapies. We present a prospective cohort of 22 patients with BCLC extended indications based on size/number (n = 17) or downstaging (n = 5) treated with LDLT between 2001 and 2014. Characteristics of the patients were as follows: median age, 57 years old; males/female, n = 20/2; Child-Pugh A/B, n = 16/6; and alpha fetoprotein < 100 ng/mL, n = 21. Twelve patients received neoadjuvant locoregional therapies. At the time of transplantation, 12 patients had HCC staging beyond Milan criteria and 10 within. Pathological reports showed that 50% exceeded BCLC expanded criteria. Perioperative mortality was 0%. After a median follow-up of 81 months, the 1-, 3-, 5-, and 10-year survival was 95.5%, 86.4%, 80.2%, and 66.8%, respectively. Overall, 7 patients recurred (range, 9-108 months), and the 5-year and 10-year actuarial recurrence rates were 23.8% and 44.4%, respectively. In conclusion, a proper selection of candidates for extended indications of LDLT for HCC patients provide survival outcomes comparable to those obtained within the Milan criteria, but these results need confirmation. Liver Transplantation 24 369-379 2018 AASLD.
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Affiliation(s)
- Josep M Llovet
- Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.,Mount Sinai Liver Cancer Program, Icahn School of Medicine at Mount Sinai, New York, NY.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - Mihai Pavel
- Liver Transplant Unit, Barcelona, Catalonia, Spain
| | - Jordi Rimola
- Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Maria Alba Diaz
- Pathology Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Colmenero
- Liver Transplant Unit, Barcelona, Catalonia, Spain.,Liver Unit, Digestive and Metabolic Diseases Institute, Barcelona, Catalonia, Spain
| | | | | | - Carmen Ayuso
- Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Josep Fuster
- Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.,Liver Transplant Unit, Barcelona, Catalonia, Spain
| | - Pere Ginès
- Liver Transplant Unit, Barcelona, Catalonia, Spain.,Liver Unit, Digestive and Metabolic Diseases Institute, Barcelona, Catalonia, Spain
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.,Liver Unit, Digestive and Metabolic Diseases Institute, Barcelona, Catalonia, Spain
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552
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Lagging M, Wejstål R, Duberg AS, Aleman S, Weiland O, Westin J. Treatment of hepatitis C virus infection for adults and children: updated Swedish consensus guidelines 2017. Infect Dis (Lond) 2018; 50:569-583. [PMID: 29495923 DOI: 10.1080/23744235.2018.1445281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM Following the approval of two new therapeutic combinations within the European Union in 2017, the former Swedish recommendations for the treatment of hepatitis C virus (HCV) infection from 2016 were deemed in need of updating. MATERIALS AND METHODS An expert meeting to this end was held in Stockholm, Sweden in October 2017. RESULTS AND CONCLUSIONS An interferon-free combination of direct-acting antiviral agents is now recommended for all patients with chronic HCV infection, regardless of liver fibrosis stage, in order to limit morbidity and spread of the disease. An extended discussion of treatment for people who inject drugs in order to diminish transmission is included.
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Affiliation(s)
- Martin Lagging
- a Department of Infectious Diseases , Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Rune Wejstål
- a Department of Infectious Diseases , Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,b Swedish Reference Group for Antiviral Therapy (RAV) , Stockholm , Sweden
| | - Ann-Sofi Duberg
- c Department of Infectious Diseases , Örebro University , Örebro , Sweden
| | - Soo Aleman
- d Department of Medicine, Division of Infectious Diseases , Karolinska Institute at Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Ola Weiland
- d Department of Medicine, Division of Infectious Diseases , Karolinska Institute at Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Johan Westin
- a Department of Infectious Diseases , Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,b Swedish Reference Group for Antiviral Therapy (RAV) , Stockholm , Sweden
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553
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Rudnick SR, Russo MW. Liver transplantation beyond or downstaging within the Milan criteria for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2018; 12:265-275. [PMID: 29231769 DOI: 10.1080/17474124.2018.1417035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unresectable hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). The Milan criteria became standard criteria but expansion beyond the Milan criteria (tumor size and number) have resulted in similar post-transplant outcomes, thus suggesting LT is a viable treatment option for HCC presenting beyond the Milan criteria Areas covered: Expanded criteria and the use of downstaging therapies to meet Milan criteria are reviewed. Surrogates of tumor biology (including biomarkers and response to therapy) are described in detail. The controversy regarding treatment of HCV infection prior to transplant for HCC is addressed. Predictors of post-transplant recurrence and therapeutic options are explored. English-language manuscripts pertaining to LT criteria for HCC, downstaging, and tumor prognosis were reviewed. Effort was made to include manuscripts from throughout the world to ensure the reader a broad international perspective. Expert commentary: Patients can be successfully transplanted with HCC beyond Milan criteria, or patients beyond Milan criteria can be downstaged to within Milan criteria and achieve successful post-liver transplant outcomes. The current reliance on tumor burden (size and number) alone ignores the mounting data supporting the prognostic use of additional surrogates of tumor biology in identifying appropriate candidates.
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Affiliation(s)
- Sean R Rudnick
- a Division of Gastroenterology , Wake Forest University School of Medicine , Winston-Salem , NC , USA
| | - Mark W Russo
- b Division of Hepatology , Carolinas HealthCare System , Charlotte , NC , USA
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554
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Samson A, Bentham MJ, Scott K, Nuovo G, Bloy A, Appleton E, Adair RA, Dave R, Peckham-Cooper A, Toogood G, Nagamori S, Coffey M, Vile R, Harrington K, Selby P, Errington-Mais F, Melcher A, Griffin S. Oncolytic reovirus as a combined antiviral and anti-tumour agent for the treatment of liver cancer. Gut 2018; 67:562-573. [PMID: 27902444 PMCID: PMC5868283 DOI: 10.1136/gutjnl-2016-312009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/26/2016] [Accepted: 10/13/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Oncolytic viruses (OVs) represent promising, proinflammatory cancer treatments. Here, we explored whether OV-induced innate immune responses could simultaneously inhibit HCV while suppressing hepatocellular carcinoma (HCC). Furthermore, we extended this exemplar to other models of virus-associated cancer. DESIGN AND RESULTS Clinical grade oncolytic orthoreovirus (Reo) elicited innate immune activation within primary human liver tissue in the absence of cytotoxicity and independently of viral genome replication. As well as achieving therapy in preclinical models of HCC through the activation of innate degranulating immune cells, Reo-induced cytokine responses efficiently suppressed HCV replication both in vitro and in vivo. Furthermore, Reo-induced innate responses were also effective against models of HBV-associated HCC, as well as an alternative endogenous model of Epstein-Barr virus-associated lymphoma. Interestingly, Reo appeared superior to the majority of OVs in its ability to elicit innate inflammatory responses from primary liver tissue. CONCLUSIONS We propose that Reo and other select proinflammatory OV may be used in the treatment of multiple cancers associated with oncogenic virus infections, simultaneously reducing both virus-associated oncogenic drive and tumour burden. In the case of HCV-associated HCC (HCV-HCC), Reo should be considered as an alternative agent to supplement and support current HCV-HCC therapies, particularly in those countries where access to new HCV antiviral treatments may be limited.
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Affiliation(s)
- Adel Samson
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Matthew J Bentham
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Karen Scott
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Gerard Nuovo
- The Ohio State University, Comprehensive Cancer Centre, Columbus, Ohio, USA
| | - Abigail Bloy
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Elizabeth Appleton
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Robert A Adair
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Rajiv Dave
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Adam Peckham-Cooper
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Giles Toogood
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | | | - Matthew Coffey
- Department of Virology II, National Institute of Infectious Diseases 1-23-1 Toyama, Tokyo, Japan
- Oncolytics Biotech, Calgary, Alberta, Canada
| | - Richard Vile
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, The Institute of Cancer Research, London, UK
| | - Kevin Harrington
- Department of Molecular Medicine, The Institute of Cancer Research, London, UK
| | - Peter Selby
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Fiona Errington-Mais
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
| | - Alan Melcher
- Department of Molecular Medicine, The Institute of Cancer Research, London, UK
| | - Stephen Griffin
- Leeds Institute of Cancer & Pathology (LICAP) and Leeds Cancer Research UK Clinical Centre, Faculty of Medicine and Health, University of Leeds, St James’ University Hospital, Leeds, UK
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555
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D'Amico G, Morabito A, D'Amico M, Pasta L, Malizia G, Rebora P, Valsecchi MG. Clinical states of cirrhosis and competing risks. J Hepatol 2018; 68:563-576. [PMID: 29111320 DOI: 10.1016/j.jhep.2017.10.020] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Abstract
The clinical course of cirrhosis is mostly determined by the progressive increase of portal hypertension, hyperdynamic circulation, bacterial translocation and activation of systemic inflammation. Different disease states, encompassing compensated and decompensated cirrhosis and a late decompensated state, are related to the progression of these mechanisms and may be recognised by haemodynamic or clinical characteristics. While these disease states do not follow a predictable sequence, they correspond to varying mortality risk. Acute-on-chronic liver failure may occur either in decompensated or in compensated cirrhosis and is always associated with a high short-term mortality. The increasing severity of these disease states prompted the concept of clinical states of cirrhosis. A multistate approach has been considered to describe the clinical course of the disease. Such an approach requires the assessment of the probabilities of different outcomes in each state, which compete with each other to occur first and mark the transition towards a different state. This requires the use of competing risks analysis, since the traditional Kaplan-Meier analysis should only be used in two-state settings. Accounting for competing risks also has implications for prognosis and treatment efficacy research. The aim of this review is to summarise relevant clinical states and to show examples of competing risks analysis in multistate models of cirrhosis.
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Affiliation(s)
- Gennaro D'Amico
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy.
| | | | - Mario D'Amico
- Radiology Department, Università di Palermo, Palermo, Italy
| | - Linda Pasta
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy
| | - Giuseppe Malizia
- Gastroenterology Unit, Ospedale V. Cervello, Via Trabucco 180, Palermo, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia Università di Milano-Bicocca, Milano, Italy
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556
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Schietroma I, Scheri GC, Pinacchio C, Statzu M, Petruzziello A, Vullo V. Hepatitis C Virus and Hepatocellular Carcinoma: Pathogenetic Mechanisms and Impact of Direct-Acting Antivirals. Open Virol J 2018; 12:16-25. [PMID: 29541275 PMCID: PMC5842384 DOI: 10.2174/1874357901812010016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/26/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Globally, between 64 and 103 million people are chronically infected with Hepatitis C virus (HCV), with more than 4.6 million people in the United States and is associated with more than 15.000 deaths annually. Chronic infection can result in cirrhosis and hepatocellular carcinoma. EXPLANATION Epidemiological studies have indicated that persistent infection with hepatitis C virus (HCV) is a major risk for the development of hepatocellular carcinoma (HCC), mainly through chronic inflammation, cell deaths, and proliferation. Despite the new direct-acting antiviral drugs (DAA's) being able to clear the HCV, HCC recurrence rate in these patients is still observed. CONCLUSION In this review we highlighted some aspects that could be involved in the onset of HCV-induced HCC such as immune system, viral factors and host genetics factors.Moreover, we focused on some of the last reports about the effects of DAA's on the HCV clearance and their potential implications in HCC recurrence.
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Affiliation(s)
- Ivan Schietroma
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
| | - Giuseppe Corano Scheri
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
| | - Claudia Pinacchio
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
| | - Maura Statzu
- Department of Molecular Medicine, Laboratory of Virology, “Sapienza” University of Rome, Rome, Italy
| | - Arnolfo Petruzziello
- Virology and Molecular Biology Unit, Department of Diagnostic Pathology, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy
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557
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Butt AS, Sharif F, Abid S. Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon? World J Hepatol 2018; 10:267-276. [PMID: 29527262 PMCID: PMC5838445 DOI: 10.4254/wjh.v10.i2.267] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Chronic hepatitis C virus infection (HCV) is the most common cause of HCC in many European countries, Japan and Pakistan. Introduction of the new direct acting antivirals (DAAs) has revolutionized the management of HCV worldwide, with high rates of sustained virologic response in patients who could not have tolerated the previous interferon based treatments. However, recently there have been reports raising caution about the long term effects of DAAs, particularly a possible increased risk of HCC. Therefore this review explores the current molecular studies as well as clinical data that investigate the impact of DAAs on occurrence and recurrence of HCC.
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Affiliation(s)
- Amna Subhan Butt
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Fatima Sharif
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Shahab Abid
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
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558
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Ogata F, Akuta N, Kobayashi M, Fujiyama S, Kawamura Y, Sezaki H, Hosaka T, Kobayashi M, Saitoh S, Suzuki Y, Suzuki F, Arase Y, Ikeda K, Kumada H. Amino acid substitutions in the hepatitis C virus core region predict hepatocarcinogenesis following eradication of HCV RNA by all-oral direct-acting antiviral regimens. J Med Virol 2018; 90:1087-1093. [PMID: 29427443 DOI: 10.1002/jmv.25047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/17/2018] [Indexed: 01/01/2023]
Abstract
Impact of substitution of aa70 in the core region (Core aa70) in HCV genotype 1b (HCV-1b) on hepatocarcinogenesis following eradication of HCV RNA by direct-acting antiviral therapy is not clear. In a retrospective study, 533 patients with HCV-related chronic liver disease, with sustained virological response defined as negative HCV RNA at 12 weeks after cessation of direct-acting antiviral therapy, were examined to evaluate the relationship between Core aa70 substitution and hepatocarcinogenesis. Twelve patients developed hepatocellular carcinoma during the follow-up period. The cumulative hepatocarcinogenesis rates were 1.7% and 2.4% at the end of 1 and 2 years, respectively. Overall, multivariate analysis identified HCV subgroup (HCV-1b with Gln70(His70); P = 0.003) and age (>65 years; P = 0.049), as pretreatment predictors of hepatocarcinogenesis. In HCV-1b patients, multivariate analysis identified post-treatment Wisteria floribunda agglutinin positive Mac-2 binding protein (>1.8 COI; P = 0.042) and HCV subgroup (HCV-1b with Gln70(His70); P = 0.071), as predictors of hepatocarcinogenesis, including post-treatment parameter. In conclusion, Core aa70 substitution in HCV-1b at the start of direct-acting antiviral therapy is an important predictor of hepatocarcinogenesis following eradication of HCV RNA. This study emphasizes the importance of detection of Core aa70 substitution before initiating antiviral therapy.
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Affiliation(s)
- Fumihiro Ogata
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Norio Akuta
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | | | | | | | - Hitomi Sezaki
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Tetsuya Hosaka
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | | | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Yasuji Arase
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Kenji Ikeda
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
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559
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Butt AA, Yan P, Simon TG, Abou-Samra AB. Effect of Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir and Ledipasvir/Sofosbuvir Regimens on Survival Compared With Untreated Hepatitis C Virus-Infected Persons: Results From ERCHIVES. Clin Infect Dis 2018; 65:1006-1011. [PMID: 28903508 DOI: 10.1093/cid/cix364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/15/2017] [Indexed: 12/17/2022] Open
Abstract
Background Interferon-based regimens are associated with a substantial survival benefit for persons infected with hepatitis C virus (HCV). Survival data with direct-acting antiviral agents are not available. We conducted this study to quantify the effect of paritaprevir/ritonavir, ombitasvir, dasabuvir (PrOD) and ledipasvir/sofosbuvir (LDV/SOF) regimens upon mortality. Methods In the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a well-established national cohort of HCV-infected Veterans, we identified HCV-infected persons initiated on PrOD or LDV/SOF, excluding those with human immunodeficiency virus, hepatitis B surface antigen positivity, hepatocellular carcinoma, or missing HCV RNA or FIB-4 scores. For each case, we identified a propensity score-matched control never initiated on treatment. Primary outcome was survival. Outcomes were assessed using frequency of events, Kaplan-Meier curves, and Cox proportional hazards regression analyses. Results We identified 1473 persons on PrOD, 5497 on LDV/SOF, and 6970 propensity score-matched untreated persons. Treated persons were more likely to be obese and have cirrhosis, but less likely to have stage 3-5 chronic kidney disease (CKD), alcohol or drug abuse or dependence diagnosis, and anemia. The proportion of persons who died was higher in the untreated group compared with either treatment group (PrOD, 0.3%; LDV/SOF, 1.4%; untreated controls, 2.5%; P < .001). A significantly larger percentage of treated patients survived to 18 months of follow-up, compared with untreated controls (P < .001). In multivariable Cox regression analysis, treatment with either regimen (hazard ratio [HR], 0.43; 95% confidence interval [CI], .33-.57) and attainment of sustained virologic response (SVR) were associated with significantly lower mortality (HR, 0.57; 95% CI, .33-.99). Conclusions Treatment with PrOD or LDV/SOF and SVR are associated with a significant mortality benefit, apparent within the first 18 months of treatment.
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Affiliation(s)
- Adeel Ajwad Butt
- Veterans Affairs Pittsburgh Healthcare System, Pennsylvania.,Weill Cornell Medical College, New York, New York and Doha, Qatar
| | - Peng Yan
- Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | - Tracey G Simon
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Abdul-Badi Abou-Samra
- Weill Cornell Medical College, New York, New York and Doha, Qatar.,Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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560
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Blanco JR, Rivero-Juárez A. The risk of hepatocellular carcinoma after sustained virological response in patients treated with the new direct-acting antiviral drugs: should we be worry about it? Expert Rev Anti Infect Ther 2018; 14:993-996. [PMID: 27686837 DOI: 10.1080/14787210.2016.1243466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- José R Blanco
- a Infectious Diseases Area , Hospital San Pedro, Center for Biomedical Research of La Rioja (CIBIR) , Logroño , La Rioja , Spain
| | - Antonio Rivero-Juárez
- b Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba , Universidad de Córdoba , Córdoba , Spain
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561
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Oxidative stress, a trigger of hepatitis C and B virus-induced liver carcinogenesis. Oncotarget 2018; 8:3895-3932. [PMID: 27965466 PMCID: PMC5354803 DOI: 10.18632/oncotarget.13904] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022] Open
Abstract
Virally induced liver cancer usually evolves over long periods of time in the context of a strongly oxidative microenvironment, characterized by chronic liver inflammation and regeneration processes. They ultimately lead to oncogenic mutations in many cellular signaling cascades that drive cell growth and proliferation. Oxidative stress, induced by hepatitis viruses, therefore is one of the factors that drives the neoplastic transformation process in the liver. This review summarizes current knowledge on oxidative stress and oxidative stress responses induced by human hepatitis B and C viruses. It focuses on the molecular mechanisms by which these viruses activate cellular enzymes/systems that generate or scavenge reactive oxygen species (ROS) and control cellular redox homeostasis. The impact of an altered cellular redox homeostasis on the initiation and establishment of chronic viral infection, as well as on the course and outcome of liver fibrosis and hepatocarcinogenesis will be discussed The review neither discusses reactive nitrogen species, although their metabolism is interferes with that of ROS, nor antioxidants as potential therapeutic remedies against viral infections, both subjects meriting an independent review.
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562
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Valadkhan S, Fortes P. Regulation of the Interferon Response by lncRNAs in HCV Infection. Front Microbiol 2018; 9:181. [PMID: 29503633 PMCID: PMC5820368 DOI: 10.3389/fmicb.2018.00181] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/26/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Saba Valadkhan
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- *Correspondence: Saba Valadkhan, Puri Fortes,
| | - Puri Fortes
- Center for Applied Medical Research, Department of Gene Therapy and Hepatology, Navarra Institute for Health Research (IdiSNA), University of Navarra, Pamplona, Spain
- *Correspondence: Saba Valadkhan, Puri Fortes,
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563
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International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Candidates. Transplantation 2018; 101:945-955. [PMID: 28437387 DOI: 10.1097/tp.0000000000001708] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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564
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Kim BH, Lim YS, Kim EY, Kong HJ, Won YJ, Han S, Park S, Hwang JS. Temporal improvement in survival of patients with hepatocellular carcinoma in a hepatitis B virus-endemic population. J Gastroenterol Hepatol 2018; 33:475-483. [PMID: 28612951 DOI: 10.1111/jgh.13848] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/16/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Over the past decade, the management of hepatocellular carcinoma (HCC) and viral hepatitis has been improved. We explored survival trends and factors affecting survival of HCC in a hepatitis B virus (HBV)-endemic population. METHODS From 31 521 and 38 167 HCC registrants to the population-based national cancer registry in Korea, an HBV-endemic country, in the period of 2003-2005 and 2008-2010, we randomly sampled cohorts of 4515 and 4582 patients, respectively, for the investigation of clinical characteristics and survival. RESULTS Compared with Cohort 2003-2005, Cohort 2008-2010 had significantly better liver function (Child-Turcotte-Pugh class A, 64.2% vs 71.6%; P < 0.001) and had more advanced tumor stages (Barcelona Clinic Liver Cancer stage B-D, 45.8% vs 50.4%; P < 0.001). HBV was the predominant cause of HCC in both cohorts (62.5% vs 62.2%; P = 0.70). Cohort 2008-2010 had significantly better overall survival than Cohort 2003-2005 by age-adjusted univariate, multivariable, and propensity score-matched analyses (median survival time, 17.2 vs 28.4 months; P < 0.001). In a subcohort analysis, a consistently significant inter-cohort improvement in survival was observed only in patients with HBV-related HCC (median survival, 16.1 vs 30.4 months; P < 0.001). The annual number of patients with HCC receiving oral antiviral agents for HBV precipitously increased from 93 in 2005 to 28 520 in 2010 in the country. CONCLUSIONS The consistent improvement in survival of patients with HCC was confined to HBV-related HCC subcohort over the last decade in an HBV-endemic population. The survival improvement coincided with the exponential use of oral antiviral agents for HBV in the patients.
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Affiliation(s)
- Bo Hyun Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.,Korean Liver Cancer Association, Seoul, Republic of Korea
| | - Young-Suk Lim
- Korean Liver Cancer Association, Seoul, Republic of Korea.,Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Yang Kim
- Korea Central Cancer Registry, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
| | - Hyun-Joo Kong
- Korea Central Cancer Registry, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
| | - Young-Joo Won
- Korea Central Cancer Registry, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Republic of Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jae Seok Hwang
- Korean Liver Cancer Association, Seoul, Republic of Korea.,Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
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565
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Cucchetti A, D'Amico G, Trevisani F, Morelli MC, Vitale A, Pinna AD, Cescon M. Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients. Dig Liver Dis 2018; 50:156-162. [PMID: 29102521 DOI: 10.1016/j.dld.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The achievement of high rates of sustained virological response (SVR) with direct-acting antivirals (DAAs) in hepatitis C virus (HCV) infected patients will reduce decompensating terminal events. AIMS To investigate whether hepatocellular carcinoma (HCC) occurrence could change due to the DAA-induced increase in life-expectancy. METHODS A Markov model was built on clinical data of 494 cirrhotic patients and available literature to estimate probabilities of "death before HCC" and of "HCC occurrence" without and with DAA. RESULTS In comparison to untreated patients, DAA therapy reduced the 20-year mortality before HCC by 21.9% in patients without varices and by 21.5% in those with varices, considering an SVR of 95% and no direct effect on hepatocarcinogenesis. Tumour occurrence increased by 5%-8.2% and the proportion of HCCs diagnosed in compensated stages increased to >98%. If we consider DAA as having "anti-tumoral" effects, the benefit becomes greater, achieving a 20-year survival of 81.5% in patients without varices, and 52.2% in patients with varices. Instead, if we consider DAA as having a "pro-tumoral" effect, then, the increased incidence of HCC nullifies the survival benefits. CONCLUSION DAAs drastically reduce the mortality caused by the liver function worsening, increasing the proportion of HCCs diagnosed in compensated stages. Knowledge of the DAA effect on hepatocarcinogenesis remains pivotal.
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Affiliation(s)
- Alessandro Cucchetti
- Department of Medical and Surgical Science - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Gennaro D'Amico
- Gastroenterology Unit, V Cervello Hospital, Ospedale V. Cervello, Palermo, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Science - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Science - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Science - DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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566
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Debes JD, van Tilborg M, Groothuismink ZMA, Hansen BE, Schulze Zur Wiesch J, von Felden J, de Knegt RJ, Boonstra A. Levels of Cytokines in Serum Associate With Development of Hepatocellular Carcinoma in Patients With HCV Infection Treated With Direct-Acting Antivirals. Gastroenterology 2018; 154:515-517.e3. [PMID: 29102620 DOI: 10.1053/j.gastro.2017.10.035] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 02/08/2023]
Abstract
Concern has arisen about the development of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) infection treated with direct-acting antivirals (DAAs). To identify patients at risk for HCC, we evaluated serum levels of immune mediators before, during, and after DAA treatment of HCV infection. Our study included 13 patients who developed HCC within 18 months after treatment (3 with HCC recurrence and 10 with new HCC) and 10 patients who did not develop HCC (controls), within at least 24 months of treatment (median, 26 months). We identified a set of 12 immune mediators (cytokines, growth factors, and apoptosis markers) whose levels were significantly higher in serum before DAA treatment of patients who eventually developed de novo HCC compared with controls. A panel of 9 cytokines, measured in serum before treatment (MIG, IL22, TRAIL, APRIL, VEGF, IL3, TWEAK, SCF, IL21), identified patients who developed de novo HCC with an area under the receiver operating characteristic curve value higher than 0.8. Further analyses of changes in levels of inflammatory cytokines during DAA treatment also provides important information about HCV-induced carcinogenesis and the effects of DAAs.
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Affiliation(s)
- Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Marjolein van Tilborg
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Zwier M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada; Toronto Center for Liver Disease, University Health Network, Toronto, Canada
| | | | - Johann von Felden
- Department of Internal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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567
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Roche B, Coilly A, Duclos-Vallee JC, Samuel D. The impact of treatment of hepatitis C with DAAs on the occurrence of HCC. Liver Int 2018; 38 Suppl 1:139-145. [PMID: 29427487 DOI: 10.1111/liv.13659] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus infection is a major cause of chronic hepatitis resulting in cirrhosis and hepatocellular carcinoma (HCC). The recent introduction of direct acting antivirals (DAA), results in sustained virological response (SVR) rates of >90% in treated patients whatever the stage of liver fibrosis with an excellent safety profile. This major advancement has allowed treatment of a larger number of patients, some with more advanced liver dysfunction and a higher risk of HCC. An SVR is associated with a reduced risk of hepatic decompensation, the need for liver transplantation and both liver-related and overall mortality. This high rate of SVR has raised hopes that there would be a significant reduction in the incidence of HCC. However, the impact of DAA-based regimens on the occurrence of HCC in patients with cirrhosis, and in particular the recurrence of HCC following successful curative treatment is controversial. Published studies suggest that DAA does not increase the risk of de novo HCC following SVR. A more controversial topic is the effect of a DAA-based SVR on the recurrence of HCC following curative treatment of early HCC. Well-designed studies with robust comparisons are needed to determine the effect of DAA on the recurrence of HCC. At present, patients with HCV cirrhosis who have undergone resection or ablation for HCC should not be dissuaded from receiving DAA therapy to prevent the progression of liver disease. Monitoring for HCC with liver imaging and AFP should be performed twice a year indefinitely post-SVR in patients with HCV cirrhosis.
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Affiliation(s)
- Bruno Roche
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Hepatinov, Villejuif, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Hepatinov, Villejuif, France
| | - Jean Charles Duclos-Vallee
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Hepatinov, Villejuif, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France.,Hepatinov, Villejuif, France
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568
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Lee S, Loecher M, Iyer R. Immunomodulation in hepatocellular cancer. J Gastrointest Oncol 2018; 9:208-219. [PMID: 29564186 PMCID: PMC5848038 DOI: 10.21037/jgo.2017.06.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fastest growing malignancy in the United States in relation to mortality. HCC relies on a complex immunosuppressive network to modify the host immune system and evade destruction. Intrinsic to the liver's function and anatomy, native hepatic and immune cells produce many inhibitory cytokines that promote tolerogenicity and limit immune response. Since the introduction of sorafenib in 2008, no treatment has been able to demonstrate improved survival in patients with advanced HCC post disease progression treated with sorafenib. More recent studies have shown that sorafenib has an immunomodulatory function in addition to inhibition of multiple tyrosine kinases. Clinical trials have aimed to further enhance this immunomodulatory function with other treatments, most promisingly immune checkpoint inhibitors. Additionally, ongoing studies are using combinatorial approaches with immunomodulatory treatment and liver directed therapies such as transarterial chemoembolization (TACE), radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. This article will review recent data describing the immunosuppressive network in HCC, recent results of immunotherapies, and combinatorial approaches to treat advanced HCC.
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Affiliation(s)
- Sunyoung Lee
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Matthew Loecher
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Renuka Iyer
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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569
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Mücke MM, Mücke VT, Lange CM, Zeuzem S. Managing hepatitis C in patients with the complications of cirrhosis. Liver Int 2018; 38 Suppl 1:14-20. [PMID: 29427491 DOI: 10.1111/liv.13636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022]
Abstract
Direct acting antivirals (DAA) have revolutionized the treatment of hepatitis C virus (HCV). Sustained virological response rates of nearly 100% have become common in the general population. However, physicians face the growing problem of managing HCV in patients with the complications of cirrhosis, eg hepatic decompensation or hepatocellular carcinoma (HCC). Safety and efficacy remain a clinical challenge in these difficult-to-treat patients. This review focuses on the current state of knowledge and treatment regimens in patients with decompensated cirrhosis as well as the potential risk of the development of HCC following DAA therapy.
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Affiliation(s)
- Marcus M Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Victoria T Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian M Lange
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
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570
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Rimola J, Díaz-González Á, Darnell A, Varela M, Pons F, Hernandez-Guerra M, Delgado M, Castroagudin J, Matilla A, Sangro B, Rodriguez de Lope C, Sala M, Gonzalez C, Huertas C, Minguez B, Ayuso C, Bruix J, Reig M. Complete response under sorafenib in patients with hepatocellular carcinoma: Relationship with dermatologic adverse events. Hepatology 2018; 67:612-622. [PMID: 28898447 DOI: 10.1002/hep.29515] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/18/2017] [Accepted: 09/01/2017] [Indexed: 12/13/2022]
Abstract
The clinical benefit of sorafenib in patients with hepatocellular carcinoma (HCC) has been undervalued due to the absence of complete responses, even though patients who develop early dermatologic reactions have shown to have a positive outcome. In addition, sorafenib is described as an antiangiogenic drug, but it also acts on immunological cells. Thus, the goal of this study was to assess the complete response rate in a retrospective cohort of HCC patients treated with sorafenib and to describe the profile of the patients who achieve complete response for identifying factors related to this event and their connection with the immunological profile of sorafenib. Ten Spanish centers submitted cases of complete response under sorafenib. The baseline characteristics, development of early dermatologic reactions, and cause of treatment discontinuation were annotated. Radiological images taken before starting sorafenib, at first control, after starting sorafenib, at the time of complete response, and at least 1 month after treatment were centrally reviewed. Of the 1119 patients studied, 20 had been classified as complete responders by the centers, but eight of these patients were excluded after central review. Ten patients had complete disappearance of all tumor sites, and two had just a small residual fibrotic scar. Thus, 12 patients were classified as complete responders (58% HCV, median age 59.7 years, 83.4% Child-Pugh class A, Eastern Cooperative Oncology Group performance status 0 91.7%, and Barcelona Clinic Liver Cancer stage C 83.3%). The median overall survival and treatment duration were 85.8 and 40.1 months, respectively. All but one patient developed early dermatologic reactions, and seven patients discontinued sorafenib after achieving complete response due to adverse events, patient decision, or liver decompensation. Conclusion: Complete response affects 1% of patients with HCC who are treated with sorafenib. The association of complete response with early dermatologic reactions supports the role of a specific immune/inflammatory patient profile in the improved response to sorafenib. (Hepatology 2018;67:612-622).
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Affiliation(s)
- Jordi Rimola
- Barcelona Clinic Liver Cancer Group, Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Álvaro Díaz-González
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain
| | - Anna Darnell
- Barcelona Clinic Liver Cancer Group, Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - María Varela
- Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Fernando Pons
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Manuel Delgado
- Servicio de Digestivo, Hospital Universitario La Coruña, La Coruña, Spain
| | - Javier Castroagudin
- Servicio de Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Matilla
- Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Bruno Sangro
- Servicio de Hepatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carlos Rodriguez de Lope
- Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Margarita Sala
- Unidad Hepatología, CIBERehd, Servicio de Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carmen Gonzalez
- Servicio de Digestivo-Sección Hepatologia Hospital General Universitario Valencia, Valencia, Spain
| | - Carlos Huertas
- Servicio de Digestivo. Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Beatriz Minguez
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Research, CIBERehd. Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carmen Ayuso
- Barcelona Clinic Liver Cancer Group, Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain
| | - María Reig
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain
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571
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Mettke F, Schlevogt B, Deterding K, Wranke A, Smith A, Port K, Manns MP, Vogel A, Cornberg M, Wedemeyer H. Interferon-free therapy of chronic hepatitis C with direct-acting antivirals does not change the short-term risk for de novo hepatocellular carcinoma in patients with liver cirrhosis. Aliment Pharmacol Ther 2018; 47:516-525. [PMID: 29205405 DOI: 10.1111/apt.14427] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/17/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) clearance with IFN-based therapies reduces the incidence of hepatocellular carcinoma (HCC). There has been some debate if IFN-free therapy with direct-acting antivirals alters the risk for HCC. AIM To investigate the HCC incidence in cirrhotic HCV patients who cleared HCV with direct-acting antivirals vs untreated controls. METHODS We prospectively monitored 373 patients with chronic hepatitis C who received IFN-free therapies with direct-acting antiviral after January 2014. A retrospective control cohort of untreated cirrhotic patients was recruited out of 3715 HCV patients who were followed at our centre between 2007 and 2013, with similar HCC screening protocols. RESULTS 158 direct-acting antiviral-treated and 184 control patients with liver cirrhosis were included in this analysis. The groups did not differ in gender and genotype distribution, severity of liver disease and prevalence of diabetes mellitus. Patients were followed up for a median of 440 (range 91-908) and 592 (range 90-1000) days. HCCs developed in 6 and 14 patients during follow-up, resulting in an incidence of 2.90 vs 4.48 HCCs per 100 person-years. In the direct-acting antiviral-treated group, there was no new case of HCC later than 450 days after treatment initiation. In multivariate analysis, higher MELD-Scores and AFP-levels were independently associated with HCC development. Transplant-free patient survival was similar in both groups. CONCLUSIONS IFN-free direct-acting antiviral therapy of chronic hepatitis C does not alter the short-term risk for HCC in patients with liver cirrhosis. A reduced HCC incidence may become evident after more than 1.5 years of follow-up.
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Affiliation(s)
- F Mettke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - B Schlevogt
- Department of Transplantation Medicine, University of Muenster, Muenster, Germany
| | - K Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Wranke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Smith
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - K Port
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Hannover Medical Hannover, Hannover, Germany.,Partner Site Hannover-Braunschweig, German Center for Infection Research (DZIF), Germany
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Hannover Medical Hannover, Hannover, Germany
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Hannover Medical Hannover, Hannover, Germany.,Partner Site Hannover-Braunschweig, German Center for Infection Research (DZIF), Germany
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572
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Kaneko R, Nakazaki N, Omori R, Yano Y, Ogawa M, Sato Y. Efficacy of direct-acting antiviral treatment for chronic hepatitis C: A single hospital experience. World J Hepatol 2018; 10:88-94. [PMID: 29399282 PMCID: PMC5787689 DOI: 10.4254/wjh.v10.i1.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of direct-acting antivirals (DAAs) in Kanto Rosai Hospital.
METHODS All patients with hepatitis C virus (HCV) who underwent DAA prescription were enrolled in this study. The present study was a single center retrospective analysis using patients infected with HCV genotype 1 or 2. Resistance analysis was performed by using direct sequencing and cycleave PCR in genotype 1 patients treated with interferon (IFN)-free DAA. The primary endpoint was sustained virologic response at 12 wk after therapy (SVR12).
RESULTS A total of 117 patients participated in the study, including 135 with genotype 1 and 42 with genotype 2. Of the 135 patients with genotype 1, 16 received protease inhibitor + IFN + ribavirin and all achieved SVR. Of the 119 patients who received IFN-free DAA (in different combinations), 102 achieved SVR and 9 failed (7/9 were on daclatasvir/asunaprevir and 2/9 on ledipasvir/sofosbuvir). Efficacy analysis was done only for 43 patients who received daclatasvir/asunaprevir. From this analysis, Y93 resistance-associated substitutions were significantly correlated with SVR.
CONCLUSION The SVR rate was 98% for genotype 1 and 100% for genotype 2. However, caution is needed for HCV NS5A resistance-associated substitutions that are selected by HCV NS5A inhibitors because cerebrovascular adverse events are induced by some DAA drugs.
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Affiliation(s)
- Rena Kaneko
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
| | - Natsuko Nakazaki
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
| | - Risa Omori
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
| | - Yuichiro Yano
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
| | - Masazumi Ogawa
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
| | - Yuzuru Sato
- Department of Gastroenterology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Nakahara Kawasaki City, Kanagawa 211-8510, Japan
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573
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Timing Is Everything: Managing Hepatitis C Virus in Liver Transplant Candidates. Transplantation 2018; 101:898-899. [PMID: 28252562 DOI: 10.1097/tp.0000000000001703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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574
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Andrade XA, Paz LH, Nassar M, Oramas DM, Fuentes HE, Kovarik P, Mishra S, Singh A. Primary Liver Diffuse Large B-Cell Lymphoma following Complete Response for Hepatitis C Infection after Direct Antiviral Therapy. Acta Haematol 2018; 139:77-80. [PMID: 29393087 DOI: 10.1159/000484653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/25/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hepatitis C infection is highly prevalent worldwide and has a well-known association with B-cell lymphoid malignancies. Antiviral therapy has successfully decreased the rate of liver cirrhosis and improved the outcome in patients with hepatitis C-associated lymphomas. However, although there are a few case reports of aggressive lymphomas after successful hepatitis C therapy, the mechanism behind this association remains unclear. CASE PRESENTATION We present the case of a 55-year-old man with chronic hepatitis C infection and liver cirrhosis who received antiviral therapy with sofosbuvir and ribavirin and achieved a sustained complete virological response. One year after successful therapy, there was an unexplained decline of his liver function and atypical liver nodularity, which led to the diagnosis of a primary liver diffuse large B-cell lymphoma. DISCUSSION We review the evidence supporting possible mechanisms of lymphomagenesis after successful hepatitis C therapy, particularly involving late "second-hit" mutations after viral-induced DNA damage and antiviral therapy facilitating the emergence of latent malignant B-cell clones by decreasing local inflammation and immune surveillance. More reports may help elucidate any association between hepatitis C antiviral therapy and late lymphoid malignancies.
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Affiliation(s)
- Xavier A Andrade
- Department of Medicine, John H. Stroger Jr. Hospital, Chicago, IL, USA
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575
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Caldas M, Del Campo L, Freih-Fraih A, García-Buey L. Liver metastasis from neuroendocrine carcinoma after the use of the new direct-action antivirals against hepatitis C virus in a patient with past history of hepatocellular carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:308-312. [PMID: 28287817 DOI: 10.17235/reed.2017.4772/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of the new direct-action antivirals against hepatitis C virus provides very high viral eradication rates. However, various recently published articles recommend caution with their use after the appearance of some cases of de novo tumors (originated in hepatic and extra-hepatic locations) and a possible shorter time period of recurrence of hepatocellular carcinomas previously treated with surgery or loco-regional therapies. The sudden drop of the number of natural killer cells secondary to the use of these new medicines has been suggested as one of the possible mechanisms responsible for this process. However, due to the controversy concerning this subject and the absence of long-term follow-up studies in clinical practice, caution is needed before definitive conclusions are settled. We present the case report of a patient diagnosed of chronic liver disease secondary to hepatitis C virus infection and a past history of hepatocellular carcinoma in complete remission after radiofrequency ablation. He was treated with the new direct-action antivirals reaching sustained viral response. Six months later, the patient was diagnosed with liver metastasis from a small-cell neuroendocrine tumor of unknown primary site.
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Affiliation(s)
- María Caldas
- Aparato Digestivo, Hospital Universitario de La Princesa, España
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576
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Campos-Varela I, Agudelo EZ, Sarkar M, Roberts JP, Terrault NA. Use of a hepatitis C virus (HCV) RNA-positive donor in a treated HCV RNA-negative liver transplant recipient. Transpl Infect Dis 2018; 20. [PMID: 29125670 DOI: 10.1111/tid.12809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 12/14/2022]
Abstract
The shortage of livers has led most transplant centers to use extended criteria donors. Hepatitis C virus (HCV) RNA-positive donor organs are typically not given to patients who have cleared HCV. A 64-year-old male with chronic hepatitis C, genotype 1b was listed for LT with hepatocellular carcinoma. While on the waiting list, the patient was treated with sofosbuvir, ledipasvir, and ribavirin and achieved an HCV RNA <15 IU/mL by week 10. At week 18 of a planned 24-week treatment course, the patient underwent deceased-donor LT and received an organ from an anti-HCV-positive donor. Treatment was stopped at LT. At week 3 post LT, HCV RNA was detectable and revealed a genotype 3 HCV infection, compatible with transplantation of an organ with established infection. With retreatment with sofosbuvir, daclatasvir, and ribavirin for 12 weeks, the patient achieved a sustained virologic response. This report highlights how antiviral therapies can be used to optimize the outcomes of HCV-infected transplant patients.
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Affiliation(s)
- Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID) and Department of Internal Medicine, Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Eliana Z Agudelo
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.,Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Monika Sarkar
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Norah A Terrault
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.,Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
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577
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N-Myc Downstream-Regulated Gene 1 Restricts Hepatitis C Virus Propagation by Regulating Lipid Droplet Biogenesis and Viral Assembly. J Virol 2018; 92:JVI.01166-17. [PMID: 29118118 DOI: 10.1128/jvi.01166-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023] Open
Abstract
Host cells harbor various intrinsic mechanisms to restrict viral infections as a first line of antiviral defense. Viruses have evolved various countermeasures against these antiviral mechanisms. Here we show that N-Myc downstream-regulated gene 1 (NDRG1) limits productive hepatitis C virus (HCV) infection by inhibiting viral assembly. Interestingly, HCV infection downregulates NDRG1 protein and mRNA expression. The loss of NDRG1 increases the size and number of lipid droplets, which are the sites of HCV assembly. HCV suppresses NDRG1 expression by upregulating MYC, which directly inhibits the transcription of NDRG1 The upregulation of MYC also leads to the reduced expression of the NDRG1-specific kinase serum/glucocorticoid-regulated kinase 1 (SGK1), resulting in a markedly diminished phosphorylation of NDRG1. The knockdown of MYC during HCV infection rescues NDRG1 expression and phosphorylation, suggesting that MYC regulates NDRG1 at both the transcriptional and posttranslational levels. Overall, our results suggest that NDRG1 restricts HCV assembly by limiting lipid droplet formation. HCV counteracts this intrinsic antiviral mechanism by downregulating NDRG1 via a MYC-dependent mechanism.IMPORTANCE Hepatitis C virus (HCV) is an enveloped single-stranded RNA virus that targets hepatocytes in the liver. HCV is a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma, and estimates suggest a global prevalence of 2.35%. Up to 80% of acutely infected individuals will develop chronic infection, and as many as 5% eventually progress to liver cancer. An understanding of the mechanisms behind virus-host interactions and viral carcinogenesis is still lacking. The significance of our research is that it identifies a previously unknown relationship between HCV and a known tumor-associated gene. Furthermore, our data point to a new role for this gene in the liver and in lipid metabolism. Thus, HCV infection serves as a great biological model to advance our knowledge of liver functions and the development of liver cancer.
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578
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Nirei K, Kanda T, Nakamura H, Matsuoka S, Takayama T, Sugitani M, Moriyama M. Persistent Hepatic Inflammation Plays a Role in Hepatocellular Carcinoma After Sustained Virological Response in Patients with HCV Infection. Int J Med Sci 2018; 15:466-474. [PMID: 29559835 PMCID: PMC5859769 DOI: 10.7150/ijms.23147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
Objective: Hepatitis C virus (HCV) infection has long been treated with interferon therapy (IFN). Currently, more than 90% of IFN-treated patients show a sustained virological response (SVR) when also treated with ribavirin and/or a protease inhibitor. Histological inflammation and fibrosis improve in IFN-treated patients, which indicates HCV clearance. IFN also reduces the incidence of hepatocellular carcinoma (HCC). However, a small proportion of patients with SVR develop HCC. To investigate the causes of hepatic carcinogenesis after SVR, we compared the liver histological findings before IFN to those after the development of HCC. Patients and methods: In total, 602 patients infected with type C chronic hepatitis or with liver cirrhosis who received IFN therapy during the period from 1992 through 2015 were included in this study. We assessed 14 of the 287 patients who achieved an SVR. Results: HCC was diagnosed by computed tomography, angiography or liver biopsy. The longest time from the SVR until HCC detection was 16.5 years, and the mean was 7.2±4.6 years. Nine of the 14 patients underwent surgery and one radiofrequency ablation. The histological findings of 10 patients were available for comparison. The comparison of the histological findings before treatment with those after the HCC diagnosis revealed an amelioration of liver fibrosis and other inflammatory changes. All ten patients showed improvements in fibrosis and steatosis. However, we observed that mild inflammatory change persisted from 1.8 years to 16.5 years after the confirmation of SVR in all cases. Conclusion: We suspect that persistent histological inflammation is one of the factors contributing to hepatocarcinogenesis (i.e., HCC development) even after successful treatment.
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Affiliation(s)
- Kazushige Nirei
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Tatsuo Kanda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Hitomi Nakamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Shunichi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | | | | | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine
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579
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De-novo versus recurrent hepatocellular carcinoma following direct-acting antiviral therapy for hepatitis C virus. Eur J Gastroenterol Hepatol 2018; 30:39-43. [PMID: 29064851 DOI: 10.1097/meg.0000000000001004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A recent appearance of direct-acting antivirals (DAAs) led to a surge in hepatitis C virus (HCV) management. Nowadays, a large proportion of treated patients have cirrhosis with a retained possibility to develop hepatocellular carcinoma (HCC) even after complete cure. We aimed to study tumoral differences between patients who developed HCC after DAAs as either a recurrence or de-novo HCC. METHODS We retrospectively analyzed 89 patients who presented to our HCC multidisciplinary clinic with HCC lesions following DAA therapy. A total of 45 patients had complete response to HCC according to the modified Response Evaluation Criteria in Solid Tumors before DAAs intake. Another 44 patients developed de-novo lesions after DAA treatment. Both groups were compared regarding their baseline characteristics, tumor criteria, response to DAAs as well response to HCC treatment. RESULTS Both groups showed no significant difference regarding their baseline characteristics (age, sex, Child-Pugh score, and performance status) or response to DAAs (P=0.5). No significant difference was present between groups according to number, site, and size of lesions. However, time elapsed between the end of DAAs therapy and first diagnosis of HCC was significantly longer in de-novo group (15.22±16.39 months) versus recurrence group (6.76±5.1 months) (P=0.008). In addition, response to ablation was significantly better in de-novo lesions compared with recurrent HCC (P=0.03). CONCLUSIONS Although de-novo HCC lesions significantly developed later than recurrent lesions in DAAs-treated patients, their response rates were significantly better. No differences were detected between both groups in their response to DAAs and their tumoral characteristics.
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580
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Tan PS, Lim SG. Editorial: hepatocellular carcinoma risk in the era of direct-acting anti-virals-is the case closed? Aliment Pharmacol Ther 2018; 47:308-309. [PMID: 29265463 DOI: 10.1111/apt.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- P S Tan
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Health System, Singapore
| | - S G Lim
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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581
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Ogawa E, Furusyo N, Nomura H, Dohmen K, Higashi N, Takahashi K, Kawano A, Azuma K, Satoh T, Nakamuta M, Koyanagi T, Kato M, Shimoda S, Kajiwara E, Hayashi J. Short-term risk of hepatocellular carcinoma after hepatitis C virus eradication following direct-acting anti-viral treatment. Aliment Pharmacol Ther 2018; 47:104-113. [PMID: 29035002 DOI: 10.1111/apt.14380] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/10/2017] [Accepted: 09/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the development of direct-acting anti-virals (DAAs), almost all patients with chronic hepatitis C virus (HCV) infection can achieve sustained viral response (SVR). AIM To evaluate the short-term risk of HCC among patients with SVR by DAAs, including those with cirrhosis or previous HCC. METHODS This large-scale, multicentre cohort study included 1,675 consecutive patients who achieved SVR by treatment with interferon-free sofosbuvir-based regimens, divided into groups with (n = 152) or without previous HCC (n = 1,523). The Kaplan-Meier method and Cox proportional hazard analysis were used to calculate the cumulative HCC incidence and related factors of HCC. RESULTS During the follow-up period (median: 17 months), 46 (2.7%) patients developed HCC. The 1-year cumulative rates of de novo HCC were 0.4% and 4.9% for the noncirrhosis and cirrhosis groups respectively (log-rank test: P < 0.001). For cirrhotic patients, serum α-fetoprotein level at the end of treatment (EOT-AFP) was the strongest predictor of de novo HCC. The 1-year cumulative de novo HCC rates were 1.4% and 13.1% in the EOT-AFP < 9.0 ng/mL and ≥ 9.0 ng/mL groups (cut-off value) respectively (log-rank test: P < 0.001). The 1-year cumulative rates of HCC recurrence were 6.5% and 23.1% for the noncirrhosis and cirrhosis groups respectively (log-rank test: P = 0.023). For cirrhotic patients, previous HCC characteristics were significantly associated with HCC recurrence. In contrast, sex, age and metabolic features did not influence de novo HCC or recurrence. CONCLUSIONS For cirrhotic patients after elimination of HCV, serum EOT-AFP level and previous HCC characteristics would be useful markers for predicting de novo HCC or recurrence.
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582
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Arisar FAQ, Hamid S. Rapid Development of Hepatocellular Carcinoma after Eradication of Hepatitis C Virus with Directly Acting Antiviral Treatment. OPEN JOURNAL OF GASTROENTEROLOGY 2018; 08:295-305. [DOI: https:/doi.org/10.4236/ojgas.2018.89032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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583
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Schlabe S, Rockstroh JK. Advances in the treatment of HIV/HCV coinfection in adults. Expert Opin Pharmacother 2017; 19:49-64. [DOI: 10.1080/14656566.2017.1419185] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Stefan Schlabe
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
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584
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Méndez-Lagares G, Lu D, Chen C, Terrault N, Segal MR, Khalili M, Monto A, Shen H, Manos MM, Lanier LL, Ryan JC, McCune JM, Hartigan-O'Connor DJ. Memory T Cell Proliferation before Hepatitis C Virus Therapy Predicts Antiviral Immune Responses and Treatment Success. THE JOURNAL OF IMMUNOLOGY 2017; 200:1124-1132. [PMID: 29263212 DOI: 10.4049/jimmunol.1701364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/30/2017] [Indexed: 01/20/2023]
Abstract
The contribution of the host immune system to the efficacy of new anti-hepatitis C virus (HCV) drugs is unclear. We undertook a longitudinal prospective study of 33 individuals with chronic HCV treated with combination pegylated IFN-α, ribavirin, and telaprevir/boceprevir. We characterized innate and adaptive immune cells to determine whether kinetics of the host response could predict sustained virologic response (SVR). We show that characteristics of the host immune system present before treatment were correlated with successful therapy. Augmentation of adaptive immune responses during therapy was more impressive among those achieving SVR. Most importantly, active memory T cell proliferation before therapy predicted SVR and was associated with the magnitude of the HCV-specific responses at week 12 after treatment start. After therapy initiation, the most important correlate of success was minimal monocyte activation, as predicted by previous in vitro work. In addition, subjects achieving SVR had increasing expression of the transcription factor T-bet, a driver of Th1 differentiation and cytotoxic effector cell maturation. These results show that host immune features present before treatment initiation predict SVR and eventual development of a higher frequency of functional virus-specific cells in blood. Such host characteristics may also be required for successful vaccine-mediated protection.
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Affiliation(s)
- Gema Méndez-Lagares
- California National Primate Research Center, University of California, Davis, Davis, CA 95616; .,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616
| | - Ding Lu
- California National Primate Research Center, University of California, Davis, Davis, CA 95616.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616
| | - Connie Chen
- California National Primate Research Center, University of California, Davis, Davis, CA 95616.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616
| | - Norah Terrault
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - Mark R Segal
- Center for Bioinformatics and Molecular Biostatistics, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94107
| | - Mandana Khalili
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143.,Division of Gastroenterology and Hepatology, San Francisco General Hospital, San Francisco, CA 94110
| | - Alexander Monto
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143.,Veterans Affairs Medical Center, San Francisco, CA 94121
| | - Hui Shen
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143.,Veterans Affairs Medical Center, San Francisco, CA 94121
| | - M Michele Manos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Lewis L Lanier
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143.,Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, CA 94129; and
| | - James C Ryan
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143.,Veterans Affairs Medical Center, San Francisco, CA 94121
| | - Joseph M McCune
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143.,Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110
| | - Dennis J Hartigan-O'Connor
- California National Primate Research Center, University of California, Davis, Davis, CA 95616.,Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616.,Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110
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585
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Adhoute X, Castellani P, Bourlière M. Impact of direct-acting antiviral agents on the risk for hepatocellular carcinoma. Transl Gastroenterol Hepatol 2017; 2:110. [PMID: 29354767 DOI: 10.21037/tgh.2017.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Xavier Adhoute
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Paul Castellani
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Marc Bourlière
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
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586
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Sugawara Y, Hibi T. Direct-acting agents for hepatitis C virus before and after liver transplantation. Biosci Trends 2017; 11:606-611. [PMID: 29238003 DOI: 10.5582/bst.2017.01293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chronic hepatitis C virus (HCV) infection remains a widespread public health concern and many people are infected with HCV. HCV is one of the leading indications for liver transplantation. Direct-acting antiviral agents (DAAs) against HCV have changed the course of chronic HCV infection, however, making it a curable disease. DAA treatment may be initiated before or after liver transplantation. In the present review, we present the available data on DAA treatment of HCV in liver transplant recipients.
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Affiliation(s)
- Yasuhiko Sugawara
- Departments of Transplantation/Pediatric Surgery and Gastroenterology and Hepatology, Postgraduate School of Life Science, Kumamoto University
| | - Taizo Hibi
- Departments of Transplantation/Pediatric Surgery and Gastroenterology and Hepatology, Postgraduate School of Life Science, Kumamoto University
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587
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Hepatocellular Carcinoma Risk After Hepatitis C Cure. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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588
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Buonomo AR, Gentile I, Borgia G. Direct acting antiviral agents and hepatocellular carcinoma development: don't take it for granted. Transl Gastroenterol Hepatol 2017; 2:101. [PMID: 29264439 DOI: 10.21037/tgh.2017.11.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
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589
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Donato MF, Invernizzi F, Rossi G, Iavarone M. Interferon-free therapy of hepatitis C during wait list and post-transplant risk of hepatocellular carcinoma recurrence. J Hepatol 2017; 67:1355-1356. [PMID: 28803950 DOI: 10.1016/j.jhep.2017.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/07/2017] [Accepted: 07/01/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Maria Francesca Donato
- "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
| | - Federica Invernizzi
- "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giorgio Rossi
- Division of General Surgery and Liver Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Massimo Iavarone
- "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
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590
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Pascasio JM, Vinaixa C, Ferrer MT, Colmenero J, Rubin A, Castells L, Manzano ML, Lorente S, Testillano M, Xiol X, Molina E, González-Diéguez L, Otón E, Pascual S, Santos B, Herrero JI, Salcedo M, Montero JL, Sánchez-Antolín G, Narváez I, Nogueras F, Giráldez Á, Prieto M, Forns X, Londoño MC. Clinical outcomes of patients undergoing antiviral therapy while awaiting liver transplantation. J Hepatol 2017; 67:1168-1176. [PMID: 28842296 DOI: 10.1016/j.jhep.2017.08.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Antiviral therapy for the treatment of hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication in patients on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy, and the clinical outcomes of these delisted patients. METHODS Observational, multicenter and retrospective analysis was carried out on prospectively collected data from patients positive for HCV, treated with an interferon-free regimen, while awaiting LT in 18 hospitals in Spain. RESULTS In total, 238 patients were enrolled in the study. The indication for LT was decompensated cirrhosis (with or without hepatocellular carcinoma [HCC]) in 171 (72%) patients, and HCC in 67 (28%) patients. Sustained virologic response (SVR) rate was significantly higher in patients with compensated cirrhosis and HCC (92% vs. 83% in patients with decompensated cirrhosis with or without HCC, p=0.042). Among 122 patients with decompensated cirrhosis without HCC, 29 (24%) were delisted due to improvement. No patient with baseline MELD score >20 was delisted. After delisting (median follow-up of 88weeks), three patients had clinical decompensations and three had de novo HCC. Only two of the patients with HCC had to be re-admitted onto the waiting list. The remaining 23 patients remained stable, with no indication for LT. CONCLUSIONS Antiviral therapy is safe and efficacious in patients awaiting LT. A quarter of patients with decompensated cirrhosis can be delisted asa result of clinical improvement, which appears to be remain stable in most patients. Thus, delisting is a safe strategy that could spare organs and benefit other patients with a more urgent need. LAY SUMMARY Antiviral therapy in patients awaiting liver transplantation is safe and efficacious. Viral eradication allows removal from the waiting list of a quarter of treated patients. Delisting because of clinical improvement is a safe strategy that can spare organs for patients in urgent need.
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Affiliation(s)
- Juan Manuel Pascasio
- UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | - Carmen Vinaixa
- Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain
| | - María Teresa Ferrer
- UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | - Jordi Colmenero
- Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Angel Rubin
- Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain
| | - Lluis Castells
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain
| | - María Luisa Manzano
- Digestive Diseases Service, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Sara Lorente
- Liver Transplant Unit, Digestive Diseases Service, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Milagros Testillano
- Liver Unit, Digestive Diseases Service, Hospital Universitario Cruces, Vizcaya, Spain
| | - Xavier Xiol
- Digestive Diseases Service, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Esther Molina
- Abdominal Transplant Unit, CHU Santiago de Compostela, IDIS, Santiago, Spain
| | | | - Elena Otón
- Digestive Diseases Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario, CIBERehd, Alicante, Spain
| | - Begoña Santos
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain
| | | | - Magdalena Salcedo
- Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain
| | - José Luis Montero
- UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Isidoro Narváez
- Digestive Diseases Service, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Flor Nogueras
- Digestive Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Álvaro Giráldez
- UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | - Martín Prieto
- Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
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591
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Sasaki R, Devhare P, Ray RB, Ray R. Hepatitis C virus-induced tumor-initiating cancer stem-like cells activate stromal fibroblasts in a xenograft tumor model. Hepatology 2017; 66:1766-1778. [PMID: 28664988 PMCID: PMC5696059 DOI: 10.1002/hep.29346] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) often causes persistent infection and is an increasingly important factor in the etiology of fibrosis/cirrhosis and hepatocellular carcinoma, although the mechanisms for the disease processes remain unclear. We have shown previously that HCV infection generates an epithelial-mesenchymal transition state and tumor-initiating cancer stem-like cells in human hepatocytes. In this study, we investigated whether HCV-induced tumor-initiating cancer stem-like cells when implanted into mice activate stromal fibroblasts. A number of fibroblast activation markers, including matrix metalloproteinase 2, were significantly increased at the mRNA or protein level in the xenograft tumors, suggesting the presence of tumor-associated fibroblasts. Fibroblast activation markers of murine origin were specifically increased in tumor, suggesting that fibroblasts migrate to form stroma. Next, we demonstrated that conditioned medium from HCV-infected human hepatocytes activates fibrosis-related markers in hepatic stellate cells. We further observed that these HCV-infected hepatocytes express transforming growth factor beta, which activates stromal fibroblast markers. Subsequent analysis suggested that anti-transforming growth factor beta neutralizing antibody, when incubated with conditioned medium from HCV-infected hepatocytes, inhibits fibrosis marker activation in primary human hepatic stellate cells. CONCLUSION HCV-infected hepatocytes induce local fibroblast activation by secretion of transforming growth factor beta, and a preneoplastic or tumor state of the hepatocytes influences the network for the tumor-associated fibroblast environment. (Hepatology 2017;66:1766-1778).
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Affiliation(s)
- Reina Sasaki
- Department of Pathology, Saint Louis University, Missouri, USA,Department of Internal Medicine, Saint Louis University, Missouri, USA
| | - Pradip Devhare
- Department of Pathology, Saint Louis University, Missouri, USA
| | - Ratna B. Ray
- Department of Pathology, Saint Louis University, Missouri, USA
| | - Ranjit Ray
- Department of Internal Medicine, Saint Louis University, Missouri, USA,Department of Molecular Microbiology & Immunology, Saint Louis University, Missouri, USA
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592
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Chtioui H. OATP1B1 and DAA treatment for hepatitis C in patients with hepatocellular carcinoma. Hepatology 2017; 66:2091. [PMID: 28960433 DOI: 10.1002/hep.29556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/07/2022]
Affiliation(s)
- Haithem Chtioui
- Division of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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593
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Mehta N, Yao FY. Con: Treating hepatitis C virus With direct-acting antivirals: Fear not the perceived threat of hepatocellular carcinoma. Liver Transpl 2017; 23:1596-1600. [PMID: 29024442 DOI: 10.1002/lt.24959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Neil Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Francis Y Yao
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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594
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Trotter JF. Pro: Direct-acting antivirals are associated with occurrence and recurrence of hepatocellular carcinoma. Liver Transpl 2017; 23:1593-1595. [PMID: 29024516 DOI: 10.1002/lt.24960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 01/13/2023]
Affiliation(s)
- James F Trotter
- Liver Transplantation, Baylor University Medical Center, Dallas, TX
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595
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Piñero F, Silva M. Dropout rate from the liver transplant waiting list because of hepatocellular carcinoma progression in hepatitis C virus-infected patients treated with direct-acting antivirals. Liver Transpl 2017; 23:1628-1629. [PMID: 29069533 DOI: 10.1002/lt.24962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/01/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Federico Piñero
- Hepatology and Liver Transplant Unit School of Medicine Hospital Universitario Austral, Austral University, Buenos Aires, Argentina
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit School of Medicine Hospital Universitario Austral, Austral University, Buenos Aires, Argentina
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596
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Waziry R, Hajarizadeh B, Grebely J, Amin J, Law M, Danta M, George J, Dore GJ. Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression. J Hepatol 2017; 67:1204-1212. [PMID: 28802876 DOI: 10.1016/j.jhep.2017.07.025] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. The aims of this study were to compare the rate of HCC occurrence in patients with HCV-related cirrhosis, following DAA vs. interferon (IFN)-based cure, and to compare the rate of HCC recurrence in patients who received curative HCC treatment, following DAA vs. IFN-based cure. METHODS A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random-effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person-years (py) among patients with a sustained virological response (SVR). RESULTS A total of 41 studies (n=13,875 patients), including 26 on HCC occurrence (IFN=17, DAA=9; prospective=19, retrospective=5, retrospective-prospective=2), and 17 on HCC recurrence (IFN=7, DAA=10; prospective=11, retrospective=5 and retrospective-prospective=1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 vs. 5.5years), and average age older (60 vs. 52years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 vs. 5.0years), but average age similar (64 vs. 66years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86-1.52) and 2.96/100 py (95% CI 1.76-4.96) in IFN and DAA studies respectively. HCC recurrence was 9.21/100 py (95% CI 7.18-11.81) and 12.16/100 py (95% CI 5.00-29.58) in IFN and DAA studies respectively. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68; 95% CI 0.18-2.55; p=0.55) or recurrence (RR 0.62, 95% CI 0.11-3.45, p=0.56). CONCLUSION There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy. LAY SUMMARY The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. We conducted a meta-analysis to compare occurrence and recurrence of HCC in patients receiving either DAA or interferon (IFN) therapy. There is no evidence that HCC occurrence or recurrence is different between patients receiving DAA or IFN therapy.
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Affiliation(s)
- Reem Waziry
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Janaki Amin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Mark Danta
- St Vincent's Clinical School, UNSW Sydney, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Sydney, Australia
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597
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Teng W, Hsieh YC, Lui KW, Chen WT, Hung CF, Huang CH, Chen YC, Jeng WJ, Lin CC, Lin CY, Lin SM, Sheen IS. Eradication of hepatitis C virus profoundly prolongs survival in hepatocellular carcinoma patients receiving transarterial chemoembolization. J Viral Hepat 2017. [PMID: 28643457 DOI: 10.1111/jvh.12745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Adjuvant pegylated interferon plus ribavirin treatment (PegIFN/RBV) reduces recurrence and prolongs survival in early stage hepatocellular carcinoma (HCC) patients with chronic hepatitis C (CHC) infection receiving resection or ablation. However, the impact of antiviral therapy in intermediate and advanced stage of CHC-HCC patients is uncertain. This study aimed to investigate the impact PegIFN/RBV treatment on recurrence-free interval and survival in patients with HCC receiving transarterial chemoembolization (TACE). From 2010 to 2013, 274 CHC patients from a 1073 patient-based cohort composed of freshly diagnosed HCC and receiving TACE treatment the Chang Gung Memorial Hospital, Linkou Medical Center were recruited. Propensity score matching (PSM) (age, gender, AST to Platelet Ratio Index (APRI), tumour size, tumour number and Child-Turcotte-Pugh score) with the ratio 1:2 for patients with and without PegIFN/RBV treatment was performed. Statistics were performed with SPSS V.20 (IBM, USA). After matching, 153 patients were analysed and 27 patients (17.6%) achieved sustained virologic response (SVR). The 2-year cumulative overall survival rate and recurrence-free survival rate among patients with SVR, non-SVR, and untreated were 85.2% vs 58.3% vs 69.6% (P=.001) and 73.3% vs 53.8% vs 58.5% (P=.013). By Cox regression analysis, non-SVR, untreated, increase CTP score and nonresponder to TACE were independent factors related to mortality. The SVR achieved by PegIFN/RBV treatment markedly improves survival and reduces tumour recurrence in CHC-HCC patients receiving TACE treatment after complete response.
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Affiliation(s)
- W Teng
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - Y-C Hsieh
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - K-W Lui
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - W-T Chen
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - C-F Hung
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - C-H Huang
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - Y-C Chen
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - W-J Jeng
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - C-C Lin
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - C-Y Lin
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - S-M Lin
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Gueishan, Taiwan
| | - I-S Sheen
- Department of Gastroenterology & Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.,College of Medicine, Chang Gung University, Gueishan, Taiwan
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598
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HCV immune evasion and regulatory T cell activation: cause or consequence? Cell Mol Immunol 2017; 15:536-538. [PMID: 29176743 DOI: 10.1038/cmi.2017.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/11/2017] [Indexed: 01/29/2023] Open
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599
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Kutala B, Valla D, Marcellin P. Things fall apart with hepatocellular carcinoma and direct-acting antivirals. Expert Opin Drug Saf 2017; 17:107-109. [PMID: 29137488 DOI: 10.1080/14740338.2018.1404026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Blaise Kutala
- a Department of Hepatology -DHU Unity , Beaujon University Hospital Paris Nord , Clichy , France.,b Inflammation Research Center , UMR 1149 INSERM, University Paris Diderot , Paris , France
| | - Dominique Valla
- a Department of Hepatology -DHU Unity , Beaujon University Hospital Paris Nord , Clichy , France
| | - Patrick Marcellin
- a Department of Hepatology -DHU Unity , Beaujon University Hospital Paris Nord , Clichy , France
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600
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Accelerated hepatocellular carcinoma recurrence rate after postoperative direct-acting antivirals treatment - preliminary report. Clin Exp Hepatol 2017; 3:194-197. [PMID: 29255807 PMCID: PMC5731431 DOI: 10.5114/ceh.2017.71483] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/23/2017] [Indexed: 12/30/2022] Open
Abstract
Aim of the study New interferon-free direct-acting antiviral (DAA) therapy has led to major progress in hepatitis C virus (HCV) treatment. Current outcomes are promising, especially in compensated cirrhosis. However, there are reports of accelerated hepatocellular carcinoma (HCC) recurrence after surgery in patients treated with DAAs. The influence of DAA therapy on the timing and frequency of recurrence after surgical treatment needs further observation. Material and methods Fifty-one HCV infected patients with advanced liver cirrhosis and history of surgical treatment for HCC in 2012-2016 were analyzed in a case-control study. Nineteen patients received DAA therapy (DAA group) after tumor remission achieved by surgery and 32 patients were not treated with DAA (NDAA group). Follow-up included multiphase computed tomography scan or magnetic resonance imaging of the liver and alpha-fetoprotein level in 3-6-month intervals. Results An sustained virological response was achieved in 18 (95%) DAA treated patients. Hepatocellular carcinoma recurrence was observed in 8 (42.1%) patients from the DAA group and in 21 (65.6%) from the NDAA group (p = 0.058). Relapse occurred within 265 days after surgery in the DAA group vs. 532 days in the NDAA group (p = 0.033). The one-year recurrence-free survival (RFS) rate was 47.3% vs. 75% in the DAA and NDAA group respectively (p = 0.45). Conclusions Use of DAA therapy in patients with a history of HCC may result in significantly accelerated relapse of the disease. The number of analyzed patients in this study is too small to state unquestionable conclusions. Further observation with a longer follow-up and larger patient group is needed. The study confirms that contemporary HCV treatment is highly effective.
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