Regional Differences in Clinical Presentation and Prognosis of Patients With Post-Sustained Virologic Response Hepatocellular Carcinoma.
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Toyoda Hidenori, Kanneganti Mounika, Melendez-Torres Jonathan, Parikh Neehar D, Jalal Prasun K, Piñero Federico, Mendizabal Manuel, Ridruejo Ezequiel, Cheinquer Hugo, Casadei-Gardini Andrea, Weinmann Arndt, Peck-Radosavljevic Markus, Dufour Jean-Francois, Radu Pompilia, Shiha Gamal, Soliman Riham, Sarin Shiv K, Kumar Manoj, Wang Jing-Houng, Tangkijvanich Pisit, Sukeepaisarnjaroen Wattana, Atsukawa Masanori, Uojima Haruki, Nozaki Akito, Nakamuta Makoto, Takaguchi Koichi, Hiraoka Atsushi, Abe Hiroshi, Matsuura Kentaro, Watanabe Tsunamasa, Shimada Noritomo, Tsuji Kunihiko, Ishikawa Toru, Mikami Shigeru, Itobayashi Ei, Singal Amit G, Johnson Philip J
Аннотация
METHODS: We identified patients with advanced fibrosis (F3/F4) who developed incident post-SVR HCC between March 2015 and October 2021 from 30 sites in Europe, North America, South America, the Middle East, South Asia, East Asia, and Southeast Asia. We compared patient demographics, liver dysfunction, and tumor burden by region. We compared overall survival by region using Kaplan-Meier analysis and identified factors associated with survival using multivariable Cox regression analysis.
RESULTS: Among 8796 patients with advanced fibrosis or cirrhosis who achieved SVR, 583 (6.6%) developed incident HCC. There was marked regional variation in the proportion of patients detected by surveillance (range: 59.5%-100%), median maximum tumor diameter (range, 1.8-5.0 cm), and the proportion with multinodular HCC (range, 15.4%-60.8%). The prognosis of patients highly varied by region (hazard ratio range, 1.82-9.92), with the highest survival rates in East Asia, North America, and South America, and the lowest survival rates in the Middle East and South Asia. After adjusting for geographic region, HCC surveillance was associated with early stage detection (Barcelona Clinic Liver Cancer stage 0/A, 71.0% vs 21.3%; P < .0001) and lower mortality rates (adjusted hazard ratio, 0.29; 95% CI, 0.18-0.46).
CONCLUSIONS: Clinical characteristics, including early stage detection, and prognosis of post-SVR HCC differed significantly across geographic regions. Surveillance utilization appears to be a high-yield intervention target to improve prognosis among patients with post-SVR HCC globally.