Oral 2 Prognostic Impact of Achieving SVR in Patients With Hepatitis C After Curative Treatment of HCC: A Systematic Review and Meta-analysis.
Author Insight from Sashidhar Manthravadi, MD, Swathi Paleti, MD, Prashant Pandya, DO, University of Kansas Medical Center
What’s new here and important for clinicians?
Hepatitis C virus infection is one of the major causes of hepatocellular carcinoma (HCC) and is responsible for 50-60% of HCC cases in the U.S. HCC remains among the deadliest of cancers, with an overall 5-year survival of approximately 12%, as most cases are diagnosed late in the course of disease. Early detection of tumors can lead to vast improvement in outcomes with curative approaches, including liver transplantation, surgical resection, and ablative therapies. Due to the limited availability of donor livers, surgical resection and loco-regional ablative techniques remain the best options for individuals with preserved synthetic function and limited tumor burden. Unfortunately, tumor recurrence at 5 years occur in up to 70% of individuals. As a recent systemic review and meta-analysis has shown significant reduction in incident development of HCC in patients with chronic hepatitis C achieving SVR, we performed a similar analysis to assess the impact of viral eradication among HCV-infected patients undergoing curative treatment for HCC. This question is of significant importance, given the recent advances in antiviral therapy that have led to marked increased SVR and substantially improved tolerance in cirrhotic individuals when compared to interferon-based therapy.
Our study highlights that achievement of SVR is indeed associated with decreased risk of tumor recurrence, and improves overall survival in patients who have undergone resection or loco-regional therapy for HCV-associated hepatocellular carcinoma. These results implicate ongoing viral replication as an important variable in tumor recurrence that we can use to our advantage, given the limited availability of effective systemic chemotherapy for hepatocellular carcinoma. Prospective studies are needed to further evaluate the utility of newer antiviral agents as an adjuvant agent in HCV-associated HCC.
What do patients need to know?
Hepatitis C infection is the major cause of liver cancer in the U.S. Liver cancer has a very poor prognosis, as most patients are not diagnosed until the disease is at an advanced stage. Screening programs for patients at risk increase the likelihood of detecting cancers at an early stage. Liver cancers diagnosed at early stage can be amenable to curative therapy such as surgical resection or ablation. Unfortunately, cancer recurrence remains a problem over time. Our study suggests that eradication of hepatitis C after curative therapy can reduce cancer recurrence and increase survival for those patients with liver cancer related to chronic hepatitis C infection.
Sashidhar Manthravadi, MD
Swathi Paleti, MD
Prashant Pandya, DO
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