Impact of peginterferon and ribavirin therapy on hepatocellular carcinoma: Incidence and survival in hepatitis C patients with advanced fibrosis

Cardoso, Ana-Carolina; Moucari, Rami; Figueiredo-Mendes, Claudio; Ripault, Marie-Pierre; Giuily, Nathalie; Castelnau, Corinne; Boyer, Nathalie; Asselah, Tarik; Martinot-Peignoux, Michelle; Maylin, Sarah; Carvalho-Filho, Roberto J.; Valla, Dominique; Bedossa, Pierre; Marcellin, Patrick

doi:10.1016/j.jhep.2009.12.028

« Previous Next »Journal of Hepatology
Volume 52, Issue 5 , Pages 652-657, May 2010

Impact of peginterferon and ribavirin therapy on hepatocellular carcinoma: Incidence and survival in hepatitis C patients with advanced fibrosis

Ana-Carolina Cardoso
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
- These authors contributed equally to this work.
Rami Moucari
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
- These authors contributed equally to this work.
Claudio Figueiredo-Mendes
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Marie-Pierre Ripault
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Nathalie Giuily
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Corinne Castelnau
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Nathalie Boyer
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Tarik Asselah
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Michelle Martinot-Peignoux
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Sarah Maylin
- Service de Microbiologie, Hôpital Beaujon, AP-HP, Clichy, France
Roberto J. Carvalho-Filho
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Dominique Valla
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
Pierre Bedossa
- Service d’Anatomie Pathologique, Hôpital Beaujon, AP-HP, Clichy, France
Patrick Marcellin
- Service d’Hépatologie, Hôpital Beaujon, AP-HP, INSERM U773-CRB3, Université Denis Diderot-Paris7, 100 Boulevard du Général Leclerc, 92110 Clichy, France
- Corresponding author. Tel.: +33 1 4087 5338; fax: +33 1 4730 9440.

Received 10 August 2009; received in revised form 27 November 2009; accepted 1 December 2009. published online 03 March 2010.

Background & Aims

Hepatocellular carcinoma (HCC) currently represents the major cause of liver-related death in patients with hepatitis C virus (HCV)-related cirrhosis. We assessed the influence of combination therapy on the risk of HCC, liver-related complications (ascites, variceal bleeding), and liver-related death (or liver transplantation).

Methods

Three hundred seven chronic hepatitis C patients with bridging fibrosis (n=127) or cirrhosis (n=180) were evaluated by Cox regression analysis. Sustained virological response (SVR) was defined as undetectable serum HCV RNA at 24weeks after treatment.

Results

SVR developed in 33% of patients. The SVR rates were not different between patients with bridging fibrosis (37%) and those with cirrhosis (30%), p=0.186. During a median follow-up of 3.5years (range 1–18years) after the last treatment, the incidence rates per 100 person-years of HCC, liver-related complications, and liver-related death, were 1.24, 0.62, and 0.61 among SVR patients, respectively, and 5.85, 4.16, and 3.76 among non-SVR patients, respectively (log-rank test, p<0.001). According to multivariate analysis, non-SVR was an independent predictor of HCC (HR 3.06; 95% CI=1.12–8.39), liver-related complications (HR 4.73; 95% CI: 1.09–20.57), and liver-related death (HR 3.71; 95% CI=1.05–13.05).

Conclusions

SVR is achieved in one-third of patients with HCV-related cirrhosis treated with peginterferon and ribavirin. SVR has a strong independent positive influence on the incidence of HCC and on the prognosis of these patients.

Abbreviations: HCC, hepatocellular carcinoma, HCV, hepatitis C virus, CHC, chronic hepatitis C, SVR, sustained virological response, TMA, transcription-mediated amplification, ALT, alanine transaminase, EASL, European Association for the Study of the Liver, AASLD, American Association for the Study of Liver Diseases

Keywords: Hepatitis C, Hepatocellular carcinoma, Advanced fibrosis, Cirrhosis, Therapy

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PII: S0168-8278(10)00088-7

doi:10.1016/j.jhep.2009.12.028

Refers to article:

Treating hepatitis C in patients with cirrhosis: The effort is worth it , 17 February 2010
Xavier Forns, Jordi Bruix
Journal of Hepatology May 2010 (Vol. 52, Issue 5, Pages 624-626)
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