Characteristics and prognosis of hepatocellular carcinoma patients after direct-acting antiviral hepatitis C virus therapy in a single medical center in Egypt

Abstract

Objective: Hepatocellular carcinoma (HCC) incidence has increased dramatically over the previous two decades and is anticipated to rise further in some countries, notably the United States, by 2030. HCC is most widespread in Asia and Africa, where hepatitis B and C are ubiquitous and lead to the development of chronic liver disease and, finally, HCC. In this study, we examined changes in the characteristics and prognosis of HCC patients, as well as the risk of developing HCC after direct-acting antiviral (DAA) medication.
Methods: The study enrolled all individuals who attended the Clinical Oncology and Nuclear Medicine Department, Suez Canal University Hospital, Ismailia, Egypt, with a proven diagnosis of HCC in the period between January 2020 and December 2021. HCC is diagnosed based on radiographic appearance (arterial enhancement phase and delayed washout phase) or compatible histology.
Results: This retrospective cohort included 254 HCC patients, separated into three groups. Kaplan-Meier curves with log-rank analysis revealed that hepatitis C virus (HCV) treatment therapy considerably reduced the time to HCC development following hepatitis diagnosis (p <.001). HCV therapy had a substantial impact on progression-free survival and overall survival in HCC patients (p <.001).
Conclusions: The emergence of DAA medication has greatly altered the management of HCV patients in the context of HCC. DAAs have been shown to be both safe and beneficial in these individuals, particularly in terms of lowering the risk of hepatic decompensation. DAAs have been reported to enhance overall survival in patients with cirrhotic HCV-related HCC, most likely due to decreased hepatic decompensation.

Keywords

Direct-acting antiviral therapy / Pegylated-interferon / Hepatitis C virus / Hepatocellular carcinoma

ACKNOWLEDGEMENTS

I would like to thank all authors for their contributions to the design of the work. Any opinions, findings, and conclusions expressed in this material are those of the authors.

AUTHORS CONTRIBUTIONS

MMA and SHS contributed to the conception and design of the work. MMA, WSAA, and SHS contributed to the collection of data from the filling system. MMA and SHS contributed to the acquisition, analysis, and interpretation of the data. MMA and SHS revised and supervised the work. SHS and MMA wrote the initial draft of the manuscript. All authors contributed to manuscript revision. All authors approved the final version of the manuscript.

FUNDING

None.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

INFORMED CONSENT

The research ethics committee of the Faculty of Medicine at Suez Canal University (FOMSCU) approved the final pro-tocol. Clinical data was collected after approval from the patients’ filling system. Confidentiality of the information and patient privacy were considered, and no personal data was published.

ETHICS APPROVAL

The Publication Ethics Committee of the Sciedu Press. The journal’s policies adhere to the Core Practices established by the Committee on Publication Ethics (COPE).

PROVENANCE AND PEER REVIEW

Not commissioned; externally double-blind peer reviewed.

DATA AVAILABILITY STATEMENT

Data will be used only in that research; this is beside the fact that patients’ contact information was required in order to minimize the problems of inaccurate recording and follow-up visits.

DATA SHARING STATEMENT

No additional data are available.

OPEN ACCESS

This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).

COPYRIGHTS

Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

References

[1] World Health Organization. Liver. Retrieved on February 28 2022. Available from:International Agency for Cancer Research. http://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf,2020

[2] El Zayadi AR, Badran HM, EMF B, et al. Hepatocellular carcinoma in Egypt: a single center study over a decade. World J. Gastroenterol. 2005; 11: 5193-8.

[3] El-Serag HB, Rudolph KL. Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis. Gastroenterology. 2007; 132: 2557-2576. https://doi.org/10.1053/j.gastro.2007.04.061

[4] Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: Part I. Diagnosis and evaluation. Am Fam Physician. 2006; 74: 756-762.

[5] Sanyal AJ, Yoon SK, Lencioni R. The Etiology of Hepatocellular Carcinoma and Consequences for Treatment. The Oncologist. 2010; 15(suppl 4): 14-22. https://doi.org/10.1634/theoncologist.2010-S4-14

[6] Yang JD, Kim WR, Coelho R, et al. Cirrhosis is present in most patients with hepatitis B and hepatocellular carcinoma. Clin Gas-troenterol Hepatol. 2011; 9: 64-70. https://doi.org/10.1016/j.cgh.2010.08.019

[7] Tang A, Hallouch O, Chernyak V, et al. Hepatocellular carcinoma epidemiology: monitoring and diagnostic target population. Abdom Radiol (NY). 2018; 43(1): 13-25. https://doi.org/10.1007/s00261-017-1209-1

[8] Neamatallah M, El Bendary M, Elalfy H, et al. The effect of TLR2 and TLR4 gene variants on HCV susceptibility, treatment response, and the development of hepatocellular carcinoma in cirrhotic HCV patients. Immunol Invest. 2019; 1-15. https://doi.org/10.1080/08820139.2019.1673772

[9] Frank C, Mohamed MK, Strickland GT, et al. The impact of par-enteral antischistosomal treatment on the propagation of hepatitis C virus in Egypt. Lancet. 2000; 355: 887-91. https://doi.org/10.1016/S0140-6736(99)06527-7

[10] Gomaa A, Allam N, Elsharkway A, et al. Hepatitis C infection in Egypt: prevalence, impact, and management strategies. Hepat Med. 2017; 9: 17-25. https://doi.org/10.2147/HMER.S113681

[11] El-Houseini ME, Ismail A, Abdelaal AA, et al. In vitro study exam-ines the impact of TGF-1 and C-Kit mutations on the development of hepatocellular carcinoma in hepatitis C virus-infected individuals. Biochem (Mosc). 2019; 84: 941-53. https://doi.org/10.1134/S0006297919080108

[12] Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:646-9. https://doi.org/10.1002/bjs.1800600817

[13] Sorensen JB, Klee M, Palshof T, Hansen HH. Performance assess-ment in cancer patients. A study of interobserver variability. Br J Cancer. 1993; 67: 773-5. https://doi.org/10.1038/bjc.1993.140

[14] Reid M, Forner A, Rimola J, et al. Update on the BCLC prognosis prediction and therapy recommendation method for 2022. J Hepatol. 2022; 76(3): 681-693. https://doi.org/10.1016/j.jhep.2021.11.018

[15] Morgan M, Rodriguez P, Worsley C.Liver Imaging Reporting & Data System (LI-RADS). Accessed on 10 February 2024. Available from: Radiopaedia.org

[16] Schwartz LH, Litière S, de Vries E, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 2016; 62:132-7 https://doi.org/10.1016/j.ejca.2016.03.081

[17] Charan J. How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine. 2013; 35(2): 121-126. https://doi.org/10.4103/0253-7176.116232

[18] Kamp WM, Sellers CM, Stein S, et al. The effects of direct act-ing antivirals on survival in patients with chronic hepatitis C and hepatocellular cancer. Scientific reports. 2019; 9(1): 17081. https://doi.org/10.1038/s41598-019-53051-2

[19] Abdelaziz AO, Nabil MM, Abdelmaksoud AH, et al. Tumor behav-ior of hepatocellular carcinoma following hepatitis C therapy with direct-acting antivirals: comparison analysis with non-direct-acting antivirals-treated patients. Eur J Gastroenterol Hepatol. 2019; 31:75-79. https://doi.org/10.1097/MEG.0000000000001264

[20] Fayoumie ME, Abdelhady M, Gawish A, et al. Changing patterns of hepatocellular carcinoma after treatment with direct antiviral agents. Gastrointest Tumors. 2020; 7: 50-60. https://doi.org/10.1159/000505326

[21] Romano A, Capra F, Piovesan S, et al. Incidence and pattern of “de novo” hepatocellular carcinoma in HCV patients treated with oral DAAs. Hepatology. 2016; 63: 10A.

[22] Singhal AG. In a multicenter North American cohort study, direct-acting antiviral therapy was not associated with the recurrence of hepatocellular carcinoma. Gastroenterology. 2019.

[23] Cabibbo G, Celsa C, Calvaruso V, et al. Direct-acting antivirals af-ter successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients. J Hepatol. 2019; 71(2): 265-73. https://doi.org/10.1016/j.jhep.2019.03.027