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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatocellular carcinoma, decompensation, and mortality based on hepatitis C treatment: A prospective cohort study
Gwang Hyeon Choi, Eun Sun Jang, Young Seok Kim, Youn Jae Lee, In Hee Kim, Sung Bum Cho, Han Chu Lee, Jeong Won Jang, Moran Ki, Hwa Young Choi, Dahye Baik, Sook-Hyang Jeong
Gwang Hyeon Choi, Eun Sun Jang, Sook-Hyang Jeong, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, South Korea
Young Seok Kim, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
Youn Jae Lee, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
In Hee Kim, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju 54907, Jeonbuk, South Korea
Sung Bum Cho, Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun 58128, South Korea
Han Chu Lee, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Jeong Won Jang, Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Moran Ki, Hwa Young Choi, Dahye Baik, Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, South Korea
Author contributions: Choi GH and Jang ES contributed equally to this work; Choi GH, Jang ES, and Jeong SH were responsible for the study concept and design, data acquisition, analysis and interpretation, statistical analysis, and manuscript drafting; Kim YS, Lee YJ, Kim IH, Cho SB, Lee HC, and Jang JW assisted with data acquisition and analysis; Ki M, Choi HY, and Baik D assisted with the data analysis and interpretation.
Supported by the Chronic Infectious Disease Cohort Study (Korea HCV Cohort Study) from the National Institute of Infectious Disease, National Institute of Health, Korea Disease Control and Prevention Agency, No. 2020-E5104-02.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of seven hospitals.
Informed consent statement: All participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: Nothing to declare.
Data sharing statement: We are not willing to share data.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sook‐Hyang Jeong, MD, PhD, Professor, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, South Korea. jsh@snubh.org
Received: March 12, 2022
Peer-review started: March 12, 2022
First decision: April 10, 2022
Revised: April 24, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 14, 2022
BACKGROUND
Prospective studies of the long-term outcomes of patients with hepatitis C virus (HCV) infection after treatment with interferon-based therapy (IBT) or direct-acting antivirals (DAA) are limited in many Asian countries.
AIM
To elucidate the incidences of hepatocellular carcinoma (HCC) and death/transplantation based on treatment with IBT or DAA, to compare the outcomes of the sustained virologic response (SVR) to IBT and DAA, and to investigate outcome-determining factors after SVR.
METHODS
This cohort included 2054 viremic patients (mean age, 57 years; 46.5% male; 27.4% with cirrhosis) prospectively enrolled at seven hospitals between 2007 and 2019. They were classified as the untreated group (n = 619), IBT group (n = 578), and DAA group (n = 857). Outcomes included the incidences of HCC and death/transplantation. The incidences of the outcomes for each group according to treatment were calculated using an exact method based on the Poisson distribution. A multivariate Cox regression analysis was performed to determine the factors associated with HCC or death/transplantation, followed by propensity score matching to confirm the results.
RESULTS
During a median of 4.1 years of follow-up, HCC and death/transplantation occurred in 113 and 206 patients, respectively, in the entire cohort. Compared with the untreated group, the incidences of HCC and death/transplantation were significantly lower in the IBT group [adjusted hazard ratio (aHR) 0.47, 95%CI: 0.28-0.80 and aHR 0.28, 95%CI: 0.18-0.43, respectively] and the DAA group (aHR 0.58, 95%CI: 0.35-0.96, and aHR 0.19, 95%CI: 0.20-0.68, respectively). Among 1268 patients who attained SVR with IBT (n = 451) or DAA (n = 816), the multivariable-adjusted analysis showed no differences in the risks of HCC (HR 2.03; 95%CI: 0.76-5.43) and death/transplantation (HR 1.38; 95%CI: 0.55-3.49) between the two groups. This was confirmed by a propensity score-matching analysis. Independent factors for HCC after SVR were age, genotype 1, and the presence of cirrhosis.
CONCLUSION
Treatment and achieving SVR with either IBT or DAA significantly reduced the incidences of HCC and mortality in the Asian patients with HCV infection. The risks of HCC and mortality were not significantly different regardless of whether SVR was induced by IBT or DAA.
Core Tip: Treatment and sustained virologic response (SVR) with either interferon-based treatment (IBT) or direct-acting antiviral (DAA) significantly reduced the incidences of hepatocellular carcinoma and mortality in our Asian prospective cohort. The risks of HCC and all-cause of mortality were not significantly different regardless of whether SVR was induced by IBT or DAA. After achieving SVR, age, the presence of cirrhosis, and genotype 1 hepatitis C virus infection were indicators of worse clinical outcomes.
