December 14, 2018
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Extrahepatic Cancer Risk Increases After HCV SVR

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Extrahepatic cancer was more common in patients with hepatitis C and was the leading cause of death in patients who achieved sustained virologic response compared with the general population, according to results of a French cohort study.

“A sustained viral response (SVR) in HCV patients and maintained viral suppression (MVR) by nucleos(t)ide analogues in HBV patients have changed the clinical course of viral cirrhosis during recent decades,” Manon Allaire, MD, from the Hospital Center University of Caen Normandie in France, and colleagues wrote. “Our results suggest a role for viral replication in the carcinogenesis of lymphoproliferative disorders, although the mechanism by which HCV may cause hematological malignancies remains unclear.”

Allaire and colleagues prospectively followed 1,671 patients with HCV, hepatitis B, or coinfection for a median of 59.7 months (range, 37.2-80.7 months). During follow-up, 225 patients developed primary liver cancer (PLC) and 93 patients developed extrahepatic cancer (EHC).

The 5-year cumulative incidence for PLC was 13.4% and was significantly higher in patients with HCV vs. those with HBV or coinfection (P = .01). After adjusting for age, PLC was more common in patients with HCV compared with the general population (P < .001).

The 5-year cumulative incidence for EHC was 5.9%. Excluding HBV, patients with HCV had a higher risk for EHC compared with the general population (P = .017).

Patients with HCV who achieved SVR after interferon therapy were less likely to develop PLC (1.46 per 100 person-years; 95% CI, 1.02-2.09) compared with those who underwent direct-acting antiviral therapy (2.57 per 100 person-years; 95% CI, 1.23-5.4).

In contrast, the incidence of EHC was higher in those who achieved SVR after IFN (1.59 per 100 person-years; 95% CI, 1.13-2.25) compared with those who underwent DAA therapy.

Older age (P < .001) and SVR (P = .047) correlated with a higher risk for EHC after multivariate analysis. Among those with HCV, risk factors for EHC included older age among those who did not achieve SVR (P = .002) and diabetes for those who achieved SVR (P = .031).

“Because DAAs are now being used in larger numbers of HCV-related patients with cirrhosis, the occurrence of PLC is expected to decrease; however, this population will live longer and will be exposed to new types of complications such as EHC, which represented the fourth most common cause of death in the cohort and the leading cause in patients who had achieved viral control,” the researchers concluded.

Disclosure: Allaire reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.