Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a dismal prognosis. Atezolizumab plus bevacizumab (atezo-bev) is the recommended palliative treatment, and approximately 10% of the patients may experience a complete response (CR), according to the mRECIST criteria. The treatment duration is until disease progression or unacceptable side effects occur. Long-term continuation can cause potential toxicities and a substantial financial burden, making early treatment discontinuation a viable option. This report describes durable CR after discontinuing atezo-bev treatment in three patients with HCC and PVTT.
Background/Aim There has been a long-standing debate about the association of directacting antiviral (DAA) therapy and hepatocellular carcinoma (HCC) recurrence. This study aimed to investigate the association between DAA therapy and HCC recurrence after curative therapy.
Methods We retrospectively enrolled 1,021 patients with HCV-related (hepatitis C virus) HCC who underwent radiofrequency ablation (RFA), liver resection, or both as the first treatment modality from January 2007 to December 2016 and without a history of HCV therapy before HCC treatment from a nationwide database. The effect of HCV treatment on HCC recurrence and all-cause mortality was also investigated.
Results Among the 1,021 patients, 77 (7.5%) were treated with DAA, 14 (1.4%) were treated with interferon-based therapy, and 930 (91.1%) did not receive HCV therapy. DAA therapy was an independent prognostic factor for lower HCC recurrence rate (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.006-0.289; P=0.001 for landmarks at 6 months after HCC treatment and HR, 0.05; 95% CI, 0.007-0.354; P=0.003 for landmarks at 1 year). Furthermore, DAA therapy was associated with lower all-cause mortality (HR, 0.049; 95% CI, 0.007-0.349; P=0.003 for landmarks at 6 months and HR, 0.063; 95% CI, 0.009-0.451; P=0.006 for landmarks at 1 year).
Conclusions DAA therapy after curative HCC treatment can decrease HCC recurrence and all-cause mortality compared to interferon-based therapy or no antiviral therapy. Therefore, clinicians should consider administering DAA therapy after curative HCC treatment in patients with HCV-related HCC.
Citations
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Comparison of Surgical Resection and Radiofrequency Ablation in Elderly Patients with Hepatocellular Carcinoma Jun Il Kim, Jayoun Lee, Gi Hong Choi, Min Woo Lee, Dong Ah Park, Jeong-Ju Yoo Digestive Diseases and Sciences.2024; 69(3): 1055. CrossRef
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Background /objective: Hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) is rarely observed in patients without liver cirrhosis (LC). We evaluated the incidence and clinical feature of HCV-associated HCC patients with or without LC.
Methods The medical records of 1,516 patients diagnosed as having primary HCC at our hospital between January 2005 and December 2017 were retrospectively reviewed. Of these, 154 (10.2%) HCV-associated HCC patients were analyzed. LC was diagnosed histologically or clinically.
Results Seventeen (11.0%) of the 154 patients had non-cirrhotic HCC, and all were of Child-Turcotte-Pugh (CTP) class A, Among the 17 patients, 88.2% were male, all had nodular type HCC, and only 2 (11.8%) were under HCC surveillance. Median overall survival (OS) of HCV-associated HCC patients with and without LC was 15 months and 37 months, respectively. Cumulative OS rates were not different between non-cirrhotic patients and cirrhotic patients with CTP class A (P=0.229). Cumulative OS rates were significantly higher in non-cirrhotic patients than in cirrhotic patients of CTP class B (P<0.001) or C (P<0.001). Multivariate analyses showed serum AST (hazard ratio [HR] 1.01, P=0.003) and AFP levels (HR 1.01, P=0.016), antiviral therapy (HR 0.25, P=0.022), and LC of CTP class B (HR, 5.24, P=0.006) or C (HR 21.79, P<0.001) were significantly associated with prognosis in HCV-associated HCC patients.
Conclusions HCC in a non-cirrhotic liver was found in 11% of HCV-associated HCC patients. OSs of HCV-associated HCC patients were better in those of CTP A, regardless of LC than in those with LC of CTP class B or C.
Citations
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Serological Biomarkers Related to
Non-Cirrhotic Hepatocellular
Carcinoma: Promising
Applications in Clinical
Diagnosis and Prognosis 进玲 刘 Advances in Clinical Medicine.2025; 15(02): 142. CrossRef
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Diagnostic performance of CT/MRI LI-RADS v2018 in non-cirrhotic hepatitis C virus infection Jennie J. Cao, Andy Shon, Luke Yoon, Aya Kamaya, Justin R. Tse Abdominal Radiology.2024;[Epub] CrossRef
A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend
to be found incidentally, but should be differentiated from malignant tumors, especially in
patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed
as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic
C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT)
revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding
suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient
had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed
for further evaluation. But abdominal US also showed atypical finding. For the confirmative
diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist®,
Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium
was done, and the patient was diagnosed as hepatic hemangioma.
Background/Aims Cirrhosis has generally been considered a prerequisite for hepatitis C
virus (HCV)-infected livers to develop hepatocellular carcinoma (HCC), but HCCs that arise
in absence of cirrhosis has been reported. We assessed the prevalence and significance of
cirrhosis in HCV-related HCC patients who underwent surgical resection. Methods A total of 78 HCC patients (65 male [83.3%]; mean age, 64.2 ± 8.6 years) were
evaluated for the presence of cirrhosis. Cirrhosis was assessed based on histology, aspartate
aminotransferase-to-platelet ratio index (APRI) as well as clinical criteria, such as ascites,
varices, thrombocytopenia, splenomegaly, and radiographic configuration of cirrhosis. Results Based on histology, cirrhosis, septal fibrosis, periportal fibrosis and no fibrosis
was noticed in 33.3%, 60.3%, 5.1% and 1.3% of patients, respectively. The clinical criteria of
cirrhosis were present in 76.9% of patients. APRI > 1.0 was seen in 47.4% of patients. There
was no evidence of cirrhosis in 18 patients (23.1%), either by histology or clinically. Cirrhosis
by histology was an independent factor for overall survival [hazard ratio: 3.87 (95% CI: 1.24 –
12.00), P=0.019]. Conclusions Quite proportion of HCC patients had no evidence of cirrhosis, either by
histology or clinically. Careful follow-up for HCC may be necessary even for non-cirrhotic HCVinfected
Korean patients. (J Liver Cancer 2014;14:108-114)