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-François; Radu, Pompilia; Shiha, Gamal; Soliman, Riham; Sarin, Shiv K; Kumar, Manoj; Wang, Jing-Houng; Tangkijvanich, Pisit; ... (2024). Regional differences in clinical presentation and prognosis of patients with post-sustained virologic response (SVR) hepatocellular carcinoma. Clinical gastroenterology and hepatology, 22(1), 72-80.e4. Elsevier 10.1016/j.cgh.2023.06.026
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BACKGROUND
& Amis: Widespread use of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection has resulted in increased numbers of patients with hepatocellular carcinoma (HCC) after achieving sustained virologic response ('post-SVR HCC') worldwide. Few data compare regional differences in presentation and prognosis of patients with post-SVR HCC.
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, 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 8,796 patients with advanced fibrosis or cirrhosis who achieved SVR, 583 (6.6%) developed incident HCC. There was marked regional variation in the proportion of detection by surveillance (range: 59.5-100%), median maximum tumor diameter (range: 1.8-5.0 cm), and proportion with multinodular HCC (range: 15.4-60.8%). Prognosis of patients highly varied by region (HR range: 1.82-9.92), with the highest survival in East Asia, North America, and South America, and lowest in the Middle East and South Asia. After adjusting for geographic region, HCC surveillance was associated with early-stage detection (BCLC stage 0/A: 71.0% vs. 21.3%, p<0.0001) and lower mortality (adjusted HR 0.29, 95%CI 0.18-0.46).
CONCLUSIONS
Clinical characteristics, including early-stage detection, and prognosis of post-SVR HCC significantly differed across geographic regions. Surveillance utilization appears to be a high-yield intervention target to improve prognosis among patients with post-SVR HCC globally.
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