Abstract
Purpose
This study tested the hypothesis that our predominately AA medical center population would demonstrate a decline in HCV-driven HCC diagnosis following the initiation of DAA treatment in 2014. Also evaluated was whether achieving an SVR prior to diagnosis of HCC improved outcomes in patients who had an HCV diagnosis after completion of treatment.
Methods
All patients with HCC seen at the Detroit Medical Center from 2009 to 2021 were identified using ICD-10 codes, and medical records were evaluated. Outcomes were evaluated as either alive or death/hospice as of December of 2022.
Results
There were 461 patients with HCC of whom 433 (94%) had racial information in the database (AA = 351; non-AA = 82). HCC incidence regardless of race peaked in 2017, with a subsequent decline through 2021. HCV as a risk factor was higher in AA as compared to non-AA (85% vs. 53% p = 0.0001). Outcome (alive vs. death/hospice) was better for SVR patients compared to untreated patients (54% vs. 19%; p = 0.0009). HCC patients who achieved SVR also had better liver function at diagnosis as defined by Child-Pugh score (74% vs. 49% Class A p = 0.04) at the time of diagnosis.
Conclusions
Racial disparity in HCC etiology was confirmed with AA more likely to have HCV than non-AA. The reduction in HCC patients with HCV confirms the impact of DAA treatment and prior successful treatment of HCV yields better outcomes. Increasing HCV treatment rates especially in AA patients will have a major impact on HCC development and treatment outcomes.
What is Known: • African Americans are more likely to have HCV infection as compared to non-AA. • Hepatocellular carcinoma is increasing in incidence in the US. • The role of HCV in the development of HCC remains to be further investigated. | |
What is New: • HCC diagnosis in a single urban medical center study increased from 2009 as a result of HCV as a risk factor. • HCC declined post 2018 due primarily to a reduction in HCV infection as the risk factor. • African Americans were more likely to have HCV as the risk factor as compared to non-AA patients who were more likely to have no known risk factor on record (i.e., cryptogenic). |
Data Availability
No datasets were generated or analyzed during the current study.
References
Henley SJ, Ward EM, Scott S, et al. Annual report to the nation on the status of cancer, part 1 national cancer statistics. Cancer. 2020;126:2225–49. https://doi.org/10.1002/cncr.32802.
White DL, Thrift AP, Kanawal F, et al. Incidence of hepatocellular carcinoma in all 50 United States from 2000 to 2012. Gastroenterology. 2017;152(4):812–20 https://doi.org/10.1053/j.gastro.2016.11.020. Epub 2016 Nov 23.
Singal AG, Lok AS, Feng Z. Conceptual model for the hepatocellular carcinoma screening continuum: current status and research agenda. Clin Gastroenterol Hepatol. 2022;20(1):9–18. Epub 2020 Sep 19.
Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650–66. https://doi.org/10.1016/j.cgh.2019.07.060. Epub 2019 Aug 8.
Kulik L, El-Seerag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology. 2019;156:471–91. https://doi.org/10.1053/j.gastro.2018.08.065. Epub 2018 Oct 24.
Pham TV, Cravero A, Feld LD, Green P, Feng Z, Berry K, Kim NJ, Vutien P, Mendoza JA, Ioannou GN. Associations of race and ethnicity with hepatocellular carcinoma, decompensation, and mortality in US veterans with cirrhosis. Cancer Epidemiol Biomarkers Prev. 2023;32(8):1069–78. https://doi.org/10.1158/1055-9965.EPI-22-1291. PMID: 37255388; PMCID: PMC10390887.
Ghouri YA, Mian I, Rowe JH. Review of hepatocellular carcinoma: epidemiology, etiology, and carcinogenesis. J Carcinog. 2017;16:1. https://doi.org/10.4103/jcar.JCar_9_16. eCollection 2017.
Ha J, Yan M, Aguilar M, et al. Race/ethnicity-specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States. Cancer. 2016;122(16):2512–23. https://doi.org/10.1002/cncr.30103. Epub 2016 May 19.
de Oliveria Andrade LJ, Argemiro D, Oliveira J, Melo RC, et al. Association between hepatitis C and hepatocellular carcinoma. J Glob Infect Dis. 2009;1(1):33–7. https://doi.org/10.4103/0974-777X.52979.
Wilder H, Saraswathula A, Hasselblad V, et al. A systematic review of race and ethnicity in hepatitis C clinical trial enrollment. J Natl Med Assoc. 2016;108(1):24–9. https://doi.org/10.1016/j.jnma.2015.12.004.
Naylor P, Sahni N, Benjaram S, et al. African American patients derive significant benefit from the dual DAA therapy: a real-world study in an urban medical center. Rem /Access. 2017;2:1054.
Naylor P, Kutaimy R, Kathi P, et al. Real world response to direct acting antivirals DAA in African americans treated in a non-gastroenterology setting. J Gastroenterol Hepatol Res. 2019;8(3):2891–5.
Stanciu C, Muzica CM, Girleanu I, et al. An update on direct antiviral agents for the treatment of hepatitis C. Expert Opin Pharmacother. 2021;22(13):1729–41. https://doi.org/10.1080/14656566.2021.1921737. Epub 2021 May 11.
Dai CY, Chuang WL, Yu ML. EASL recommendations on treatment of hepatitis C: final update of the series - some issues. J Hepatol. 2021;74(2):473–4. https://doi.org/10.1016/j.jhep.2020.10.013. Epub 2020 Nov 19.
Ji F, Yeo YH, Wei MT, et al. Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: a systematic review and meta-analysis. J Hepatol. 2019;71:473–85. Epub 2019 May 13.
Nahon P, Bourcier V, Layese R, et al. Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications. Gastroenterology. 2017;152(1):142–56. https://doi.org/10.1053/j.gastro.2016.09.009. Epub 2016 Sep 15.
Waziry R, Hajarizadeh B, Grebely J, et al. Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: a systematic review, meta-analyses, and meta-regression. J Hepatol. 2017;67(6):1204–12. https://doi.org/10.1016/j.jhep.2017.07.025. Epub 2017 Aug 9.
Singal AG, Rich NE, Mehta N, et al. Direct-acting antiviral therapy not associated with recurrence of hepatocellular carcinoma in a multicenter north American cohort study. Gastroenterology. 2019;156(6):1683–92. https://doi.org/10.1053/j.gastro.2019.01.027. Epub 2019 Jan 18.
Yeh M-L, Liang PC, Tsai P, et al. Characteristics and survival outcomes of hepatocellular carcinoma developed after HCV SVR. Cancers. 2021;13:3455. https://doi.org/10.3390/cancers13143455.
Dang H, Yeo YH, Yasuda S, et al. Cure with interferon-free direct-acting antiviral is associated with increased survival in patients with hepatitis C virus-related hepatocellular carcinoma from both east and west. Hepatology. 2020;71:1910–22. https://doi.org/10.1002/hep.30988. Epub 2020 May 8.
Lockart I, Hajarizadeh B, Alavi M, et al. Hepatitis C virus cure before hepatocellular carcinoma diagnosis is associated with improved survival. J Viral Hepat. 2021;28:710–8. https://doi.org/10.1111/jvh.13475. Epub 2021 Feb 2.
He S, Lockart I, Alavi M, et al. Systematic review with meta-analysis: effectiveness of direct-acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma. Aliment Pharmacol Ther. 2020;51(1):34–529. https://doi.org/10.1111/apt.15598. Epub 2019 Dec 6.
Lockart I, Yeo MGH, Hajarizadeh B, Dore GJ, Danta M. HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: a meta-analysis. Hepatology. 2022;76:139–54. https://doi.org/10.1002/hep.32341.
Ryu T, Takami Y, Wada Y, et al. Effect of achieving sustained virological response before hepatitis C virus-related hepatocellular carcinoma occurrence on survival and recurrence after curative surgical microwave ablation. Hepatol Int. 2018;12(2):149–57. https://doi.org/10.1007/s12072-018-9851-4. Epub 2018 Feb 27.
Singal AG, Rich NE, Mehta N, et al. Direct-acting antiviral therapy for hepatitis C virus infection is associated with increased survival in patients with a history of hepatocellular carcinoma. Gastroenterology. 2019;157(5):1253–63. https://doi.org/10.1053/j.gastro.2019.07.040. Epub 2019 Jul 30.
Ioannou GN, Beste LA, Green PK, et al. Increased risk for hepatocellular carcinoma persists up to 10 years after HCV eradication in patients with baseline cirrhosis or high FIB-4 scores. Gastroenterology. 2019;157(5):1264–78. https://doi.org/10.1053/j.gastro.2019.07.033. Epub 2019 Jul 26.
Hall EW, Rosenberg ES, Sullivan PS. Estimates of state-level chronic hepatitis C virus infection, stratified by race and sex, United States, 2010. BMC Infect Dis. 2018;18(1):224. https://doi.org/10.1186/s12879-018-3133-6.
Lazarus JV, Picchio CA, Colombo M. Hepatocellular carcinoma prevention in the era of hepatitis C elimination. Int J Mol Sci. 2023;24(18):14404. https://doi.org/10.3390/ijms241814404.
Chen Q, Ayer T, Adee MG, Wang X, Kanwal F, Chhatwal J. Assessment of incidence of and surveillance burden for hepatocellular carcinoma among patients with hepatitis c in the era of direct-acting antiviral agents. JAMA Netw Open. 2020;3:e2021173. https://doi.org/10.1001/jamanetworkopen.2020.21173. [.
Leal C, Strogoff-de-Matos J, Theodoro C, Teixeira R, Perez R, Guaraná T, de Tarso Pinto P, Guimarães T, Artimos S. Incidence and risk factors of hepatocellular carcinoma in patients with chronic hepatitis C treated with direct-acting antivirals. Viruses. 2023;15(1):221. https://doi.org/10.3390/v15010221.
Kanwal F, Kramer JR, Asch SM, Cao Y, Li L, El-Serag HB. Long-term risk of hepatocellular carcinoma in HCV patients treated with direct acting antiviral agents. Hepatology. 2020;71(1):44–55. https://doi.org/10.1002/hep.30823. Epub 2019 Aug 19.
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M.I.I, B.F, M.W, B.R, and A.W collected the data. B.R and P.N analyzed the data. M.I.I and B.F drafted the abstract. P.N prepared the manuscript. M.I.I, A.W, T.W, B.R, E.W.B, M.E, P.N, and M.M reviewed the manuscript.
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Itani, M.I., Farah, B., Wasvary, M. et al. Impact of DAA Treatment for HCV on Hepatocellular Carcinoma in a Predominately African American Population. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-024-01076-w
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DOI: https://doi.org/10.1007/s12029-024-01076-w