Low Hepatitis C Viral Load Predicts Better Long-Term Outcomes in Patients Undergoing Resection of Hepatocellular Carcinoma Irrespective of Serologic Eradication of Hepatitis C Virus

Junichi Shindoh, Kiyoshi Hasegawa, Yutaka Matsuyama, Yosuke Inoue, Takeaki Ishizawa, Taku Aoki, Yoshihiro Sakamoto, Yasuhiko Sugawara, and Norihiro Kokudo, University of Tokyo
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2012; 31(6). DOI: 10.1200/JCO.2012.44.3234
Source: PubMed


PURPOSEHepatitis C virus (HCV) infection has been recognized as a potent risk factor for the postoperative recurrence of hepatocellular carcinoma (HCC). However, little is known about the impact of HCV viral load on surgical outcomes. The study objective was to investigate clinical significance of HCV viral load on long-term outcomes of HCC. PATIENTS AND METHODS
Three hundred seventy patients who were classified as Child-Pugh class A and underwent curative liver resections for HCV-related HCC were divided into low and high viral load groups (≤ or > 5.3 log(10)IU/mL) based on the results of a minimum P value approach to predict moderate to severe activity of hepatitis; the clinical outcomes were then compared.ResultsThe 5-year recurrence-free survival rate was 36.1% in the low viral load group and 12.4% in the high viral load group (P < .001). The 5-year overall survival rate was 76.6% in the low viral load group and 57.7% in the high viral load group (P < .001). Multivariate analysis confirmed significant correlation between high viral load and tumor recurrence with a hazard ratio of 1.87 (95% CI, 1.41 to 2.48; P < .001). Subanalysis revealed that the favorable results in the low viral load group were not attributed to whether or not serologic eradication of HCV was obtained both in primary and recurrent lesions. CONCLUSION
Low HCV viral load predicts better long-term surgical outcomes in patients with HCC regardless of the serologic eradication of HCV.

1 Read
  • Journal of Clinical Oncology 03/2013; 31(12). DOI:10.1200/JCO.2012.48.5367 · 18.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A specific prognostication of hepatitis C virus positive diffuse large B cell lymphomas is not available. At this purpose, the Fondazione Italiana Linfomi carried out a multicenter retrospective study on a large consecutive series of patients with hepatitis C virus-associated diffuse large B cell lymphoma, to evaluate the prognostic impact of clinical and virological features and to develop a specific prognostic score for this subset of patients. All prognostic evaluations were performed on 535 patients treated with an anthracycline-based induction regimen (with rituximab in 255 cases). Severe hepatotoxicity was observed in 14% of patients. The use of rituximab was not associated with increased rate of severe hepatotoxicity. Three-year overall survival and progression-free survival were 71% and 55%, respectively. At multivariate analysis, ECOG performance status ≥2, serum albumin <3.5 g/dl and HCV-RNA viral load >1000 KIU/ml retained prognostic significance. We combined these 3 factors in a new HCV Prognostic Score able to discriminate 3 risk categories with different overall and progression-free survival (low=0; intermediate=1; high-risk ≥2 factors, p<0.001). This score retained prognostic value in the subgroups of patients treated with and without rituximab (p<0.001). The new score performed better than International Prognostic Index at multivariate analysis and Harrel C-statistic. With the use of three readily available factors (performance status, albumin level and HCV-RNA viral load), the new HCV Prognostic Score is able to identify three risk-categories with different survival, and may be a useful tool to predict the outcome of hepatitis C virus-associated diffuse-large B cell-lymphoma.
    Haematologica 11/2013; 99(3). DOI:10.3324/haematol.2013.094318 · 5.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: The new standard of care for treatment-naïve patients with hepatitis C virus (HCV) genotype 1 includes triple therapy with peginterferon, ribavirin, and a protease inhibitor. However, patients who achieve a rapid virologic response after 4 weeks of peginterferon and ribavirin therapy are likely to achieve a sustained virologic response (SVR), and we hypothesized that protease inhibitor therapy may be unnecessary in these patients. Treatment-naïve, noncirrhosis patients infected with genotype-1 HCV and a low viral load at baseline were considered for inclusion (n = 233). After 4 weeks of lead-in therapy with peginterferon α-2b and ribavirin, 101 patients (48%) had a rapid virologic response (defined as undetectable levels of hepatitis C virus RNA at 4 weeks) and were eligible to participate. Patients were randomized 1:1 to 20 weeks of additional therapy with peginterferon α-2b and ribavirin (double therapy) or to 24 weeks of peginterferon α-2b, ribavirin, and boceprevir (triple therapy). There was no significant difference in rates of SVR-12 in patients treated with double versus triple therapy. This similarity persisted regardless of viral subtype (genotype 1a or 1b), interleukin (IL)-28b genotype (CC or non-CC), or ethnicity (African American versus non-Hispanic white). Conclusion: Protease inhibitor therapy could be obviated in genotype 1-infected treatment-naïve patients with low viral load at baseline who achieve undetectable viremia after 4 weeks of peginterferon/ribavirin.
    Hepatology 01/2014; 59(1). DOI:10.1002/hep.26624 · 11.06 Impact Factor
Show more