| Title: |
Undefined/non-malignant hepatic nodules are associated with early occurrence of HCC in DAA-treated patients with HCV-related cirrhosis |
| Authors: |
Sangiovanni A.; Alimenti E.; Gattai R.; Filomia R.; Parente E.; Valenti L.; Marzi L.; Pellegatta G.; Borgia G.; Gambato M.; Terreni N.; Serio I.; Belli L.; Oliveri F.; Maimone S.; Brunacci M.; D'Ambrosio R.; Forzenigo L. V.; Russo F. P.; Rumi M.; Barone M.; Fracanzani A. L.; Raimondo G.; Giannini E. G.; Brunetto M. R.; Villa E.; Biganzoli E.; Colombo M.; Lampertico P. |
| Contributors: |
A. Sangiovanni; E. Alimenti; R. Gattai; R. Filomia; E. Parente; L. Valenti; L. Marzi; G. Pellegatta; G. Borgia; M. Gambato; N. Terreni; I. Serio; L. Belli; F. Oliveri; S. Maimone; M. Brunacci; R. D'Ambrosio; L.V. Forzenigo; F.P. Russo; M. Rumi; M. Barone; A.L. Fracanzani; G. Raimondo; E.G. Giannini; M.R. Brunetto; E. Villa; E. Biganzoli; M. Colombo; P. Lampertico |
| Publisher Information: |
Elsevier |
| Publication Year: |
2020 |
| Collection: |
The University of Milan: Archivio Istituzionale della Ricerca (AIR) |
| Subject Terms: |
Cirrhosi; Direct-acting antiviral; Hepatocellular carcinoma; Non-malignant liver nodule; Undefined liver nodules; Settore MED/12 - Gastroenterologia |
| Description: |
Background & Aim: An unexpected early increase in incidence, recurrence and clinical aggressiveness of hepatocellular carcinoma (HCC) has been reported (and refuted) in patients with HCV-related cirrhosis following direct-acting antiviral (DAA) treatment. To address this controversy, we performed a prospective multicenter study on consecutively enrolled cirrhotic patients, with or without a history of HCC, undergoing DAA therapy. Patients and methods: A total of 1,161 HCC-free cirrhotics (group 1) and 124 cirrhotics who had received a curative treatment for an HCC (group 2) were enrolled. Clinical features, including presence of undefined/non-malignant liver nodules (UNMNs), were analyzed with respect to HCC incidence and recurrence. Results: During a median study time of 17 months in group 1 and 16 months in group 2, de novo HCC developed in 48 patients (yearly incidence 3.1/100 patient-years, 75% BCLC 0-A) and recurred in 40 (mean yearly incidence 29.9/100 patient-years, 83% BCLC 0-A). A peak of HCC instant incidence was observed at 4.2 months in group 1 patients with UNMNs, and at 7.7 months in group 2. By multivariable Cox regression models, UNMNs (hazard ratio [HR] 3.11; 95% CI 1.47–6.57: p = 0.003), ascites detected any time before enrolment (HR 3.04; 95% CI 1.23–7.51; p = 0.02), and alpha-fetoprotein log-value (HR 1.90; 95% CI 1.05–3.44; p = 0.03) were the variables independently associated with the incidence of de novo HCC, while history of alcohol abuse (HR 2.10; 95% CI 1.08–4.09; p = 0.03) and history of recurrence of HCC (HR 2.87; 95% CI 1.35–6.09; p = 0.006) were associated with HCC recurrence. Conclusion: An early high incidence of both de novo HCC, in patients with UNMNs, and recurrent HCC was observed in DAA-treated patients; this was not accompanied by increased tumor aggressiveness. Lay summary: This prospective study focuses on the risk of developing de novo or recurrent hepatocellular carcinoma (HCC) after direct-acting antiviral (DAA) treatment in patients with hepatitis C-related ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/32243959; info:eu-repo/semantics/altIdentifier/wos/WOS:000562756400055; volume:73; issue:3; firstpage:593; lastpage:602; numberofpages:10; journal:JOURNAL OF HEPATOLOGY; https://hdl.handle.net/2434/776884 |
| DOI: |
10.1016/j.jhep.2020.03.030 |
| Availability: |
https://hdl.handle.net/2434/776884; https://doi.org/10.1016/j.jhep.2020.03.030 |
| Rights: |
info:eu-repo/semantics/closedAccess |
| Accession Number: |
edsbas.5E5B09A1 |
| Database: |
BASE |