HCC in the era of direct-acting antiviral agents (DAAs): surgical and other curative or palliative strategies in the elderly
| Autor: | Giuseppe Maria De Sanctis, Caterina Furlan, Antonio Ciardi, Chiara D’Alterio, Michele Di Martino, Jessica Antimi, Rosa Maria Pascale, Pierleone Lucatelli, Simone Bini, Marsia Tancredi, Chiara De Lucia, Mario Bezzi, Stefania Brozzetti, Vittoria Carolina Malpassuti |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
hepatitis C virus
Cancer Research medicine.medical_specialty Hepatitis C virus medicine.disease_cause Gastroenterology Article surgery hepatocellular carcinoma HCV HCC HCC recurrence DAA locoregional therapy 03 medical and health sciences chemistry.chemical_compound Liver disease 0302 clinical medicine Fibrosis Internal medicine medicine neoplasms RC254-282 business.industry Ribavirin Significant difference Neoplasms. Tumors. Oncology. Including cancer and carcinogens Retrospective cohort study medicine.disease digestive system diseases Oncology chemistry 030220 oncology & carcinogenesis Hepatocellular carcinoma 030211 gastroenterology & hepatology business Direct acting |
| Zdroj: | Cancers Volume 13 Issue 12 Cancers, Vol 13, Iss 3025, p 3025 (2021) |
| Popis: | Hepatocellular carcinoma (HCC) accounts for 75–85% of primary liver malignancies, and elderlies have the highest incidence rates. Direct-acting antiviral agents (DAAs) have shown satisfying results in terms of HCV sustained viral response (SVR). However, data regarding HCC risk post-DAA-SVR is still conflicting. This study aims to consider HCC onset in moderate underlying liver disease. We conducted a retrospective study on 227 chronically infected patients (cHCV), treated with DAAs. Patients were divided into three groups: “de novo occurrent HCC”, “recurrent HCC”, and “without HCC”. Fifty-six patients aged < 65 years (yDAA) were studied separately. HCC patients aged ≥65 years (DAA-HCC) were compared to a historical group of 100 elderly HCC patients, treated with peginterferon (Peg-IFN) ± ribavirin antiviral agents, non-SVR (hHCC). The HCC prevalence in DAA patients was 32.75%: “de novo occurrent’’ 18.13% and “recurrent’’ 14.62%, despite 42.85% of them having no fibrosis to mild or moderate fibrosis (F0-F1-F2). yDAA showed 5.36% “de novo occurrent” HCC. Curative procedure rates were compared between DAA-HCC and hHCC at the first and at recurrent presentation (22 (39.29%) vs. 72 (72%) 17 (30.36%) vs. 70 (70%), respectively (p < 0.001)). No significant difference was found in 3-year OS (p = 0.6). However, in cause-specific mortality analysis, HCC-related death was higher in the DAA-treated group, whereas cirrhosis-related death was more common in the historical group (p = 0.0288), considering together the two causes of death. A more accurate patient stratification according to multifactorial and new diagnostic investigations identifying HCC risk might allow an improvement in management and access to curative therapies. |
| Databáze: | OpenAIRE |
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