PMID- 30959157
OWN - NLM
STAT- Publisher
LR  - 20190408
IS  - 1600-0641 (Electronic)
IS  - 0168-8278 (Linking)
DP  - 2019 Apr 5
TI  - Direct acting antivirals after successful treatment of early hepatocellular
      carcinoma improve survival in HCV-cirrhotic patients.
LID - S0168-8278(19)30221-1 [pii]
LID - 10.1016/j.jhep.2019.03.027 [doi]
AB  - BACKGROUND & AIMS: The effectiveness of direct-acting antivirals (DAAs) against
      hepatitis C virus (HCV) after successful treatment of early hepatocellular
      carcinoma (HCC) has been studied extensively. However, the benefit in terms of
      overall survival (OS) remains to be conclusively demonstrated. The aim of this
      study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic
      decompensation. METHODS: We enrolled prospectively 163 consecutive patients with 
      HCV-related cirrhosis and at first diagnosis of early Barcelona Clinic Liver
      Cancer (BCLC) 0/A HCC who had achieved a complete radiologic response after
      curative resection or ablation, subsequently treated with DAAs. DAA-untreated
      patients from ITA.LI.CA. cohort (n=328) served as controls. After
      propensity-score matching, outcomes of 102 DAA-treated (DAA group) and 102
      DAA-untreated patients (No DAA group) were compared. RESULTS: In DAA group, 7/102
      patients (6.9%) died, HCC recurred in 28/102 patients (27.5%) and hepatic
      decompensation occurred in 6/102 patients (5.9%), after a mean follow-up of 21.4 
      months. OS was significantly higher in DAA group compared with No DAA group
      (hazard ratio [HR]=0.39; 95% confidence Interval [CI]=0.17-0.91, p=0.03). HCC
      recurrence was not significantly different between DAA and No DAA groups
      (HR=0.70; 95% CI=0.44-1.13, p=0.15). A significant reduction in the rate of
      hepatic decompensation was observed in DAA group compared with No DAA group
      (HR=0.32; 95% CI=0.13-0.84, p=0.02). In DAA group, sustained virologic response
      was a significant predictor of overall survival (HR 0.02, 95% CI 0.00-0.19,
      p<0.001), HCC recurrence (HR 0.25, 95% CI 0.11-0.57, p<0.001) and hepatic
      decompensation (HR 0.12, 95% CI 0.02-0.38, p=0.02). CONCLUSIONS: In patients with
      HCV-related cirrhosis and previous successful treatment of early HCC, DAAs
      significantly improved OS compared with No DAA treatment. Word Abstract Count:
      274 words LAY SUMMARY: In patients with compensated cirrhosis who are infected
      with hepatitis C virus (HCV) and at first diagnosis of early hepatocellular
      carcinoma (HCC) (without history of HCC recurrence before DAA treatment) who had 
      achieved a complete radiologic response after curative resection or ablation,
      direct-acting antivirals (DAAs) significantly improve overall survival and reduce
      risk for hepatic decompensation compared with propensity-score-matched patients
      who did not receive DAAs. In contrast, the risk for HCC recurrence is not
      significantly reduced in DAA group compared to No DAA group.
CI  - Copyright (c) 2019 European Association for the Study of the Liver. Published by 
      Elsevier B.V. All rights reserved.
FAU - Cabibbo, Giuseppe
AU  - Cabibbo G
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Celsa, Ciro
AU  - Celsa C
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Calvaruso, Vincenza
AU  - Calvaruso V
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Petta, Salvatore
AU  - Petta S
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Cacciola, Irene
AU  - Cacciola I
AD  - UOC Epatologia Clinica e Biomolecolare, AOUP G. Martino, Dipartimento di Medicina
      Interna e Sperimentale, University of Messina, Italy.
FAU - Cannavo, Maria Rita
AU  - Cannavo MR
AD  - UOS Epatologia, ARNAS Garibaldi-Nesima, Catania, Italy.
FAU - Madonia, Salvatore
AU  - Madonia S
AD  - UOC Medicina Interna, AO Villa Sofia-Cervello, Palermo, Italy.
FAU - Rossi, Margherita
AU  - Rossi M
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Magro, Bianca
AU  - Magro B
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Rini, Francesca
AU  - Rini F
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Distefano, Marco
AU  - Distefano M
AD  - UOC Malattie Infettive, Ospedale Umberto I, Siracusa, Italy.
FAU - Larocca, Licia
AU  - Larocca L
AD  - UOC Malattie Infettive, AOUP G. Rodolico, Catania, Italy.
FAU - Prestileo, Tullio
AU  - Prestileo T
AD  - UOC Malattie Infettive, ARNAS Civico-Di Cristina-Benefratelli, Palermo, Italy.
FAU - Malizia, Giuseppe
AU  - Malizia G
AD  - UOC Gastroenterologia, AO Villa Sofia-Cervello, Palermo, Italy.
FAU - Bertino, Gaetano
AU  - Bertino G
AD  - UOC Medicina Interna, AOUP G. Rodolico, Catania, Italy.
FAU - Benanti, Francesco
AU  - Benanti F
AD  - UOC Malattie Infettive, ARNAS Garibaldi-Nesima, Catania, Italy.
FAU - Licata, Anna
AU  - Licata A
AD  - UOC Medicina Interna, AOUP Paolo Giaccone, Palermo, Italy.
FAU - Scalisi, Ignazio
AU  - Scalisi I
AD  - UOC Medicina Interna, Ospedale di Mazzara del Vallo, ASP, Trapani, Italy.
FAU - Mazzola, Giovanni
AU  - Mazzola G
AD  - UOC Malattie Infettive, Azienda Ospedaliera Universitaria Paolo Giaccone,
      Palermo, Italy.
FAU - Di Rosolini, Maria Antonietta
AU  - Di Rosolini MA
AD  - UOC Malattie Infettive, Ospedale di Modica; ASP Ragusa, Italy.
FAU - Alaimo, Giuseppe
AU  - Alaimo G
AD  - UOC Medicina Interna, Ospedale di Agrigento, ASP Agrigento, Italy.
FAU - Averna, Alfonso
AU  - Averna A
AD  - UOC Malattie Infettive, Ospedale di Caltanissetta, ASP Caltanissetta, Italy.
FAU - Cartabellotta, Fabio
AU  - Cartabellotta F
AD  - UOC Medicina Interna, Ospedale Buccheri La Ferla, Palermo, Italy.
FAU - Alessi, Nicola
AU  - Alessi N
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Guastella, Salvatore
AU  - Guastella S
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Russello, Maurizio
AU  - Russello M
AD  - UOS Epatologia, ARNAS Garibaldi-Nesima, Catania, Italy.
FAU - Scifo, Gaetano
AU  - Scifo G
AD  - UOC Malattie Infettive, Ospedale Umberto I, Siracusa, Italy.
FAU - Squadrito, Giovanni
AU  - Squadrito G
AD  - UOC Epatologia Clinica e Biomolecolare, AOUP G. Martino, Dipartimento di Medicina
      Interna e Sperimentale, University of Messina, Italy.
FAU - Raimondo, Giovanni
AU  - Raimondo G
AD  - UOC Epatologia Clinica e Biomolecolare, AOUP G. Martino, Dipartimento di Medicina
      Interna e Sperimentale, University of Messina, Italy.
FAU - Trevisani, Franco
AU  - Trevisani F
AD  - Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater
      Studiorum - University of Bologna, Italy.
FAU - Craxi, Antonio
AU  - Craxi A
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Di Marco, Vito
AU  - Di Marco V
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy.
FAU - Camma, Calogero
AU  - Camma C
AD  - Section of Gastroenterology and Hepatology, Dipartimento di Promozione della
      Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza
      (PROMISE), University of Palermo, Italy. Electronic address:
      calogero.camma@unipa.it.
CN  - Rete Sicilia Selezione Terapia - HCV (RESIST-HCV), Italian Liver Cancer
      (ITA.LI.CA.) Group
LA  - eng
PT  - Journal Article
DEP - 20190405
PL  - Netherlands
TA  - J Hepatol
JT  - Journal of hepatology
JID - 8503886
OTO - NOTNLM
OT  - Liver cirrhosis
OT  - Overall survival
OT  - Prognosis
OT  - Survival rate
OT  - direct acting antiviral (DAA)
OT  - hepatitis C virus (HCV)
OT  - hepatocellular carcinoma (HCC)
EDAT- 2019/04/09 06:00
MHDA- 2019/04/09 06:00
CRDT- 2019/04/09 06:00
PHST- 2018/08/14 00:00 [received]
PHST- 2019/03/02 00:00 [revised]
PHST- 2019/03/22 00:00 [accepted]
PHST- 2019/04/09 06:00 [entrez]
PHST- 2019/04/09 06:00 [pubmed]
PHST- 2019/04/09 06:00 [medline]
AID - S0168-8278(19)30221-1 [pii]
AID - 10.1016/j.jhep.2019.03.027 [doi]
PST - aheadofprint
SO  - J Hepatol. 2019 Apr 5. pii: S0168-8278(19)30221-1. doi:
      10.1016/j.jhep.2019.03.027.