Cargando…

Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis

BACKGROUND: Successful treatment of hepatitis C reduces liver inflammation and fibrosis; however, patients remain at risk of developing hepatocellular carcinoma (HCC). AIMS: To identify risk factors for new‐onset HCC in patients cured of hepatitis C. METHODS: Imaging, histological, and clinical data...

Descripción completa

Detalles Bibliográficos
Autores principales: Rocha, Chiara, Doyle, Erin H., Bowman, Chip A., Fiel, M‐Isabel, Stueck, Ashley E., Goossens, Nicolas, Bichoupan, Kian, Patel, Neal, Crismale, James F., Makkar, Jasnit, Lewis, Sara, Perumalswami, Ponni V., Schiano, Thomas D., Hoshida, Yujin, Schwartz, Myron, Branch, Andrea D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225173/
https://www.ncbi.nlm.nih.gov/pubmed/37078924
http://dx.doi.org/10.1002/cam4.5711
_version_ 1785050342362185728
author Rocha, Chiara
Doyle, Erin H.
Bowman, Chip A.
Fiel, M‐Isabel
Stueck, Ashley E.
Goossens, Nicolas
Bichoupan, Kian
Patel, Neal
Crismale, James F.
Makkar, Jasnit
Lewis, Sara
Perumalswami, Ponni V.
Schiano, Thomas D.
Hoshida, Yujin
Schwartz, Myron
Branch, Andrea D.
author_facet Rocha, Chiara
Doyle, Erin H.
Bowman, Chip A.
Fiel, M‐Isabel
Stueck, Ashley E.
Goossens, Nicolas
Bichoupan, Kian
Patel, Neal
Crismale, James F.
Makkar, Jasnit
Lewis, Sara
Perumalswami, Ponni V.
Schiano, Thomas D.
Hoshida, Yujin
Schwartz, Myron
Branch, Andrea D.
author_sort Rocha, Chiara
collection PubMed
description BACKGROUND: Successful treatment of hepatitis C reduces liver inflammation and fibrosis; however, patients remain at risk of developing hepatocellular carcinoma (HCC). AIMS: To identify risk factors for new‐onset HCC in patients cured of hepatitis C. METHODS: Imaging, histological, and clinical data on patients whose first HCC was diagnosed >12 months of post‐SVR were analyzed. Histology of 20 nontumor tissues was analyzed in a blinded manner using the Knodel/Ishak/HAI system for necroinflammation and fibrosis/cirrhosis stage and the Brunt system for steatosis/steatohepatitis. Factors associated with post‐SVR HCC were identified by comparison with HALT‐C participants who did not develop post‐SVR HCC. RESULTS: Hepatocellular carcinoma was diagnosed in 54 patients (45 M/9F), a median of 6 years of post‐SVR [interquartile range (IQR) =1.4‐10y] at a median age of 61 years (IQR, 59–67). Approximately one‐third lacked cirrhosis, and only 11% had steatosis on imaging. The majority (60%) had no steatosis/steatohepatitis in histopathology. The median HAI score was 3 (1.25–4), indicating mild necroinflammation. In a multivariable logistic regression model, post‐SVR HCC was positively associated with non‐Caucasian race (p = 0.03), smoking (p = 0.03), age > 60 years at HCC diagnosis (p = 0.03), albumin<3.5 g/dL (p = 0.02), AST/ALT>1 (p = 0.05), and platelets <100 × 10(3) cells/μL (p < 0.001). Alpha fetoprotein ≥4.75 ng/mL had 90% specificity and 71% sensitivity for HCC occurrence. Noncirrhotic patients had larger tumors (p = 0.002) and a higher prevalence of vascular invasion (p = 0.016) than cirrhotic patients. CONCLUSIONS: One‐third of patients with post‐SVR HCC did not have liver cirrhosis; most had no steatosis/steatohepatitis. Hepatocellular carcinomas were more advanced in noncirrhotic patients. Results support AFP as a promising marker of post‐SVR HCC risk.
format Online
Article
Text
id pubmed-10225173
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-102251732023-05-29 Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis Rocha, Chiara Doyle, Erin H. Bowman, Chip A. Fiel, M‐Isabel Stueck, Ashley E. Goossens, Nicolas Bichoupan, Kian Patel, Neal Crismale, James F. Makkar, Jasnit Lewis, Sara Perumalswami, Ponni V. Schiano, Thomas D. Hoshida, Yujin Schwartz, Myron Branch, Andrea D. Cancer Med RESEARCH ARTICLES BACKGROUND: Successful treatment of hepatitis C reduces liver inflammation and fibrosis; however, patients remain at risk of developing hepatocellular carcinoma (HCC). AIMS: To identify risk factors for new‐onset HCC in patients cured of hepatitis C. METHODS: Imaging, histological, and clinical data on patients whose first HCC was diagnosed >12 months of post‐SVR were analyzed. Histology of 20 nontumor tissues was analyzed in a blinded manner using the Knodel/Ishak/HAI system for necroinflammation and fibrosis/cirrhosis stage and the Brunt system for steatosis/steatohepatitis. Factors associated with post‐SVR HCC were identified by comparison with HALT‐C participants who did not develop post‐SVR HCC. RESULTS: Hepatocellular carcinoma was diagnosed in 54 patients (45 M/9F), a median of 6 years of post‐SVR [interquartile range (IQR) =1.4‐10y] at a median age of 61 years (IQR, 59–67). Approximately one‐third lacked cirrhosis, and only 11% had steatosis on imaging. The majority (60%) had no steatosis/steatohepatitis in histopathology. The median HAI score was 3 (1.25–4), indicating mild necroinflammation. In a multivariable logistic regression model, post‐SVR HCC was positively associated with non‐Caucasian race (p = 0.03), smoking (p = 0.03), age > 60 years at HCC diagnosis (p = 0.03), albumin<3.5 g/dL (p = 0.02), AST/ALT>1 (p = 0.05), and platelets <100 × 10(3) cells/μL (p < 0.001). Alpha fetoprotein ≥4.75 ng/mL had 90% specificity and 71% sensitivity for HCC occurrence. Noncirrhotic patients had larger tumors (p = 0.002) and a higher prevalence of vascular invasion (p = 0.016) than cirrhotic patients. CONCLUSIONS: One‐third of patients with post‐SVR HCC did not have liver cirrhosis; most had no steatosis/steatohepatitis. Hepatocellular carcinomas were more advanced in noncirrhotic patients. Results support AFP as a promising marker of post‐SVR HCC risk. John Wiley and Sons Inc. 2023-04-20 /pmc/articles/PMC10225173/ /pubmed/37078924 http://dx.doi.org/10.1002/cam4.5711 Text en © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle RESEARCH ARTICLES
Rocha, Chiara
Doyle, Erin H.
Bowman, Chip A.
Fiel, M‐Isabel
Stueck, Ashley E.
Goossens, Nicolas
Bichoupan, Kian
Patel, Neal
Crismale, James F.
Makkar, Jasnit
Lewis, Sara
Perumalswami, Ponni V.
Schiano, Thomas D.
Hoshida, Yujin
Schwartz, Myron
Branch, Andrea D.
Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title_full Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title_fullStr Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title_full_unstemmed Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title_short Hepatocellular carcinoma in patients cured of chronic hepatitis C: Minimal steatosis
title_sort hepatocellular carcinoma in patients cured of chronic hepatitis c: minimal steatosis
topic RESEARCH ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225173/
https://www.ncbi.nlm.nih.gov/pubmed/37078924
http://dx.doi.org/10.1002/cam4.5711
work_keys_str_mv AT rochachiara hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT doyleerinh hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT bowmanchipa hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT fielmisabel hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT stueckashleye hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT goossensnicolas hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT bichoupankian hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT patelneal hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT crismalejamesf hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT makkarjasnit hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT lewissara hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT perumalswamiponniv hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT schianothomasd hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT hoshidayujin hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT schwartzmyron hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis
AT branchandread hepatocellularcarcinomainpatientscuredofchronichepatitiscminimalsteatosis