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Early decompensation predicts mortality in successfully treated HCC

The most significant risk factor for mortality in patients with hepatitis C-related cirrhosis and successfully treated hepatocellular carcinoma was hepatic decompensation within the first year of follow-up, according to a recently published study.

“This study showed indirect evidence that, in HCV patients with early stage HCC who achieved a complete radiological response after curative treatment, HCV eradication can have an important role in the short- and long-term preservation of liver function, resulting in a lower cirrhosis-related mortality and in an increased chance of receiving curative treatments if HCC recurs,” Giuseppe Cabibbo, MD, from the University of Palermo, Italy, and colleagues wrote. “Moreover, the cure of the infection may curb the risk of late recurrences that are probably driven by the severity of underlying disease.”

The study comprised 328 patients with HCV-related Barcelona Clinic Liver Cancer (BCLC) stage A HCC who showed complete radiological response after either thermal ablation (n = 240) or surgical resection (n = 88). Mean patient age was 69.4 years, 217 were men and the mean MELD score was 8.6. Mean length of follow-up was 32 months (range, 3-95 months).

Compared with patients who underwent thermal ablation, those who underwent resection were younger (64 vs. 71 years; P < .001), had a lower MELD score (8.1 vs. 8.7; P = .03) and had a lower prevalence of esophageal varices (25% vs. 43%; P = .002).

During follow-up, 142 patients had HCC recurrence; 63 recurring before 12 months and 79 recurring after 12 months. Recurrence rates were 21% at 1 year, 55% at 3 years and 64% at 5 years. Eighty-one patients had decompensation occur during follow-up. Decompensation rates were 10% at 1 year, 30% at 3 years and 44% at 5 years. Sixty-six patients died. Mortality rates were 97% at 1 year, 79% at 3 years and 63% at 5 years.

The independent predictors of overall mortality were early hepatic decompensation (HR = 7.52; 95% CI, 1.23-13.48), early HCC recurrence (HR = 2.5; 95% CI, 1.23-5.05), age (HR = 1.04; 95% CI, 1.02-1.07) and the presence of esophageal varices at baseline (HR = 1.66; 95% CI, 1.02-2.7).

“Patients with cirrhosis due to HCV should be monitored for HCC regardless of HCV clearance,” the researchers concluded. “This would allow diagnosis of potentially curative early stage disease ... using treatments, such as liver transplantation or, in most cases surgical resection or local ablation.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.