Liver-related events after direct-acting antiviral therapy in patients with hepatitis C virus-associated cirrhosis.
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Tahata Yuki, Hikita Hayato, Mochida Satoshi, Enomoto Nobuyuki, Kawada Norifumi, Kurosaki Masayuki, Ido Akio, Miki Daiki, Yoshiji Hitoshi, Takikawa Yasuhiro, Sakamori Ryotaro, Hiasa Yoichi, Nakao Kazuhiko, Kato Naoya, Ueno Yoshiyuki, Yatsuhashi Hiroshi, Itoh Yoshito, Tateishi Ryosuke, Suda Goki, Takami Taro, Nakamoto Yasunari, Asahina Yasuhiro, Matsuura Kentaro, Yamashita Taro, Kanto Tatsuya, Akuta Norio, Terai Shuji, Shimizu Masahito, Sobue Satoshi, Miyaki Tomokatsu, Moriuchi Akihiro, Yamada Ryoko, Kodama Takahiro, Tatsumi Tomohide, Yamada Tomomi, Takehara Tetsuo
Аннотация
METHODS: A total of 350 patients with compensated and decompensated cirrhosis administered DAA therapy at 29 Japanese hospitals were enrolled (Child-Pugh class A [CP-A]: 195 patients, CP-B: 131 patients and CP-C: 24 patients).
RESULTS: The SVR rates of patients with CP-A, CP-B and CP-C were 96.9%, 93.1% and 83.3%, respectively (p = 0.006). Seventy patients developed hepatocellular carcinoma (HCC), and male sex, previous HCC treatment, platelet counts < 10.0 × 104/µl, alpha-fetoprotein levels ≥ 5.0 ng/ml and CP-C were identified as significant factors in the multivariate analysis. The cumulative HCC occurrence/recurrence rates at 1 year were 6.6%/45.2%. The cumulative rate of decompensated cirrhotic events requiring hospital admission at 1 year was 9.1%. In the multivariate analysis, CP-B and CP-C were identified as significant factors. During the median observation period of 14.9 months, 13 patients died and one patient received liver transplant. The overall survival rates at 1 year were 98.4% in patients with CP-A, 96.4% in those with CP-B and 85.6% in those with CP-C (CP-A vs. CP-B: p = 0.759, CP-A vs. CP-C: p = 0.001 and CP-B vs. CP-C: p = 0.005).
CONCLUSIONS: HCC development and mortality in patients with CP-B were not different from those with CP-A. On the other hand, in patients with CP-C, the development of HCC and decompensated cirrhotic events requiring hospital admission, and death were frequent.
TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN000036150).