Development of hepatocellular carcinoma in patients with hepatitis C virus infection who achieved sustained virological response following interferon therapy: A large-scale, long-term cohort study

• Published in: Journal of gastroenterology and hepatology Vol. 31; no. 5; pp. 1009 - 1015
• Main Authors: Nagaoki, Yuko, Aikata, Hiroshi, Nakano, Norihito, Shinohara, Fumi, Nakamura, Yuki, Hatooka, Masahiro, Morio, Kei, Kan, Hiromi, Fujino, Hatsue, Kobayashi, Tomoki, Fukuhara, Takayuki, Masaki, Keiichi, Ono, Atsushi, Nakahara, Takashi, Kawaoka, Tomokazu, Miki, Daiki, Tsuge, Masataka, Hiramatsu, Akira, Imamura, Michio, Takahashi, Shoichi, Kawakami, Yoshiiku, Ochi, Hidenori, Chayama, Kazuaki
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-05-2016
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; alpha-Fetoproteins - analysis; Antiviral Agents - therapeutic use; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - virology; Chi-Square Distribution; Child; Female; Hepatitis C - complications; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C virus; hepatocellular carcinoma; Humans; interferon therapy; Interferons - therapeutic use; Kaplan-Meier Estimate; Liver Cirrhosis - diagnosis; Liver Cirrhosis - virology; Liver Function Tests; Liver Neoplasms - blood; Liver Neoplasms - diagnosis; Liver Neoplasms - virology; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Factors; sustained viral responders; Sustained Virologic Response; Time Factors; Treatment Outcome; Up-Regulation; Young Adult; α-fetoprotein; hepatitis C virus; interferon therapy; α-fetoprotein; hepatocellular carcinoma; sustained viral responders
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13236

Background:
We assessed the risk factors for the development of hepatocellular carcinoma (HCC) following successful eradication of hepatitis C virus (HCV) with interferon (IFN) therapy in a long‐term, large‐scale cohort study.
Methods:
We reviewed 1094 consecutive patients with HCV who achieved sustained virological response (SVR) following IFN therapy between January 1995 and September 2013.
Results:
During the observation period (median 50 months: range 13–224), 36 (3%) of 1094 patients developed HCC after SVR. The median period from SVR to diagnosis of HCC was 37 months (range 17–141), and the cumulative rates of HCC at 5, 10, and 15 years were 4%, 6%, and 12%, respectively. Multivariate analysis identified old age (≥60 years, HR, 3.1: 95%CI, 1.3–6.6: P = 0.009), male sex (HR, 12.0: 95%CI, 2.8–50.0: P < 0.0001), advanced fibrosis stage (F3/4, HR, 3.2: 95%CI, 1.6–7.2: P < 0.0001), and alpha‐fetoprotein ≥10 ng/mL at 1 year after SVR (HR, 7.8: 95%CI, 2.9–16.8: P < 0.0001) as significant and independent risk factors for post‐SVR HCC.
Conclusions:
Older age and male sex (host factors), advanced fibrosis stage (pre‐IFN treatment factor), and higher alpha‐fetoprotein values (post‐treatment factor) were significantly associated with HCC development after HCV eradication.