Spotlight on hepatocellular cancer

One recent study assessed occurrence of hepatocellular carcinoma in patients with hepatitis C-associated cirrhosis, while another looked at the effect of hepatobiliary cancer surveillance on outcomes in patients with primary sclerosing cholangitis.

Recent studies assessed the incidence of hepatocellular carcinoma in patients with hepatitis C virus (HCV) infection and cirrhosis and surveillance of hepatobiliary cancer in patients with primary sclerosing cholangitis.

In the first study, published online on April 12 by Gastroenterology, researchers assessed hepatocellular carcinoma occurrence in 2,249 consecutive patients with HCV-associated cirrhosis who were treated with direct-acting antivirals from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy.

Most patients had Child-Pugh class A disease (90.5%), whereas the other 9.5% were Child-Pugh class B. Overall, 2,140 (95.2%) patients achieved a sustained virologic response, and 78 (3.5%) patients developed hepatocellular carcinoma during a mean follow-up of 14 months.

One year after antiviral exposure, hepatocellular carcinoma developed in 2.1% of Child-Pugh class A patients with a sustained virologic response and 6.6% of those with no sustained virologic response. In Child-Pugh class B patients, hepatocellular carcinoma developed in 7.8% of those with a sustained virologic response and 12.4% of those with no sustained virologic response.

The study authors noted limitations, such as a short follow-up period after sustained virologic response and potential heterogeneity among centers in the diagnosis of hepatocellular carcinoma. “In conclusion, our prospective observational study confirms that the early benefit of viral eradication in HCV cirrhosis persists throughout all stages of cirrhosis,” they wrote.

The second study found that hepatobiliary cancer surveillance may improve outcomes, including survival, in patients with primary sclerosing cholangitis. Researchers assessed the effect of surveillance in 79 patients with primary sclerosing cholangitis who were seen at Mayo Clinic in Rochester, Minn., between 1995 to 2015, developed hepatobiliary cancers, and had at least one year of follow-up. Results were published online on April 19 by Hepatology.

Overall, 54 (78%) patients developed cholangiocarcinoma, 17 (21%) patients developed hepatocellular carcinoma, five (6%) patients developed gallbladder carcinoma, two (3%) developed both cholangiocarcinoma and hepatocellular carcinoma, and one (1%) developed both hepatocellular carcinoma and gallbladder carcinoma.

Forty (51%) of 79 patients were under hepatobiliary cancer surveillance and, compared to those who were not, had higher overall survival at five years (68% vs. 20%; P<0.001) and lower five-year probability of experiencing a hepatobiliary cancer-related adverse event (32% vs. 75%; P<0.001).

The authors noted limitations of the study, such as its retrospective nature and the fact that it did not include a cost analysis. Despite the study's positive results, they wrote that survival remains “subsatisfactory” in patients with hepatobiliary cancer complicating primary sclerosing cholangitis and called for better methods for earlier diagnosis.