Changes in the presentation and characteristics OF HCV related hepatocellular carcinoma in the era of direct acting antiviral therapy: A retrospective study

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology Pub Date : 2025-03-03 DOI:10.1016/j.clinre.2025.102567

Randa Salah Abdelmoneim, Fathalla Sedki, Mohamed Fathy Bakosh

{"title":"Changes in the presentation and characteristics OF HCV related hepatocellular carcinoma in the era of direct acting antiviral therapy: A retrospective study","authors":"Randa Salah Abdelmoneim, Fathalla Sedki, Mohamed Fathy Bakosh","doi":"10.1016/j.clinre.2025.102567","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is the sixth common malignancy worldwide. In Egypt, the main cause of HCC is hepatitis C virus (HCV)-related cirrhosis. After the successful mass treatment program of HCV in 2018 with direct-acting antivirals (DAAs) therapy, a large percentage of patients have been treated and effectively achieved sustained virological response (SVR). Recently, some studies claimed that HCCs that developed after treatment with DAAs have more aggressive behavior. Purpose of the study is to detect the possible change of HCC pattern before and after DAAs era and its effect on overall survival (OS).</div></div><div><h3>Methods</h3><div>428 naïve HCC patients were divided into 2 groups: Group I HCC patients not treated with DAAs and Group II HCC patients treated with DAAs. Then we compared demographic, clinical, radiological, and laboratory characteristics between both groups.</div></div><div><h3>Results</h3><div>Group II had improved liver function tests, including serum bilirubin, albumin, and international normalized ratio, than Group I (<em>p</em> < 0.001, <em>p</em> < 0.001, <em>p</em> < 0.001, respectively). They had a lower level of liver aminotransferases. Group II showed a larger infiltrative pattern of HCC, with a high incidence of portal vein thrombosis (<em>p</em> = 0.003, <em>p</em> < 0.001, <em>p</em> = 0.048, respectively). Group II received more curative or palliative treatment options, while 55 % of Group I received the best supportive care. There was no significant difference in 1-year and 2-years OS between both group, except that group II patients had better 2-year OS in subgroup BCLC stage C.</div></div><div><h3>Conclusion</h3><div>The tumor pattern has changed into a more aggressive phenotype after DAAs. DAAs have succeeded in preserving the liver condition. However, they did not demonstrate any protective effect on the OS of the patients. There is a strong need for strict screening program for early detection of HCC in the early stages, that are eligible for curative options, after HCV treatment of DAAs<strong>.</strong></div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 4","pages":"Article 102567"},"PeriodicalIF":2.6000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics and research in hepatology and gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2210740125000476","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Hepatocellular carcinoma (HCC) is the sixth common malignancy worldwide. In Egypt, the main cause of HCC is hepatitis C virus (HCV)-related cirrhosis. After the successful mass treatment program of HCV in 2018 with direct-acting antivirals (DAAs) therapy, a large percentage of patients have been treated and effectively achieved sustained virological response (SVR). Recently, some studies claimed that HCCs that developed after treatment with DAAs have more aggressive behavior. Purpose of the study is to detect the possible change of HCC pattern before and after DAAs era and its effect on overall survival (OS).

Methods

428 naïve HCC patients were divided into 2 groups: Group I HCC patients not treated with DAAs and Group II HCC patients treated with DAAs. Then we compared demographic, clinical, radiological, and laboratory characteristics between both groups.

Results

Group II had improved liver function tests, including serum bilirubin, albumin, and international normalized ratio, than Group I (p < 0.001, p < 0.001, p < 0.001, respectively). They had a lower level of liver aminotransferases. Group II showed a larger infiltrative pattern of HCC, with a high incidence of portal vein thrombosis (p = 0.003, p < 0.001, p = 0.048, respectively). Group II received more curative or palliative treatment options, while 55 % of Group I received the best supportive care. There was no significant difference in 1-year and 2-years OS between both group, except that group II patients had better 2-year OS in subgroup BCLC stage C.

Conclusion

The tumor pattern has changed into a more aggressive phenotype after DAAs. DAAs have succeeded in preserving the liver condition. However, they did not demonstrate any protective effect on the OS of the patients. There is a strong need for strict screening program for early detection of HCC in the early stages, that are eligible for curative options, after HCV treatment of DAAs.

查看原文本刊更多论文

直接抗病毒治疗时代HCV相关肝细胞癌的表现和特征的变化：一项回顾性研究

背景：肝细胞癌（HCC）是全球第六大常见恶性肿瘤。在埃及，HCC的主要原因是丙型肝炎相关的肝硬化。在2018年成功实施直接作用抗病毒药物（DAAs）治疗HCV的大规模治疗计划后，很大比例的患者得到了治疗，并有效实现了持续病毒学反应（SVR）。最近，一些研究声称，在DAA治疗后发生的hcc具有更强的侵袭性行为。目的：探讨DAAs时代前后HCC形态可能发生的变化及其对总生存期（OS）的影响。方法：将428例naïve HCC患者分为未接受daa治疗的I组HCC患者和接受daa治疗的II组HCC患者。然后我们比较两组的人口学、临床、放射学和实验室特征。结果：ⅱ组患者血清胆红素、白蛋白、国际标准化比值均较ⅰ组改善（p< 0.001, p< 0.001, p< 0.001）。他们的肝脏转氨酶水平较低。II组HCC浸润性更大，门静脉血栓发生率高（p= 0.003, p< 0.001, p= 0.048）。第二组接受了更多的治愈性或姑息性治疗方案，而第一组55%的患者接受了最好的支持性治疗。两组患者的1年和2年OS无显著差异，但II组患者在BCLC c期亚组中有更好的2年OS。结论：DAAs后肿瘤模式转变为更具侵袭性的表型。DAAs成功地保存了肝脏状况。然而，它们并没有显示出对患者OS的任何保护作用。在HCV治疗DAAs后，需要严格的筛查程序，以便在早期发现HCC，有资格获得治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinics and research in hepatology and gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.30

自引率

3.70%

发文量

198

审稿时长

42 days

期刊介绍： Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct). Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.