Aliment Pharmacol Ther. 2018 Jun 19. doi: 10.1111/apt.14848. [Epub ahead of print]
Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long-term analogue therapy for hepatitis B.
Loglio A1, Iavarone M1, Grossi G1, Viganò M2, Rumi MG2, Facchetti F1, Lunghi G3, Sangiovanni A1, Colombo M4, Lampertico P1.
Author information
1
CRC "A.M. e A. Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
2
Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
3
Virology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
4
Center for Translational Hepatology Research, Clinical and Research Center, Humanitas Hospital, Rozzano, Italy.
Abstract
BACKGROUND:
Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development.
AIMS:
To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients.
METHODS:
All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied.
RESULTS:
Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second-line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%.
CONCLUSIONS:
HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.
1
CRC“A.M. e A. Migliavacca”肝病研究中心，胃肠病学和肝病学部，Fondazione IRCCSCàGranda Ospedale Maggiore Policlinico，意大利米兰大学米兰大学。
2
意大利米兰Universitàdegli Studi di Milano，意大利Ospedale San Giuseppe医院肝病科。
3
Virology Unit，Fondazione IRCCSCàGranda Ospedale Maggiore Policlinico，意大利米兰Universitàdegli Studi di Milano，米兰。
4
意大利罗扎诺市Humanitas医院临床研究中心转化肝病研究中心。