Background & Aims
Hepatocellular carcinoma (HCC) currently represents the major cause of liver-related death in patients with hepatitis C virus (HCV)-related cirrhosis. We assessed the influence of combination therapy on the risk of HCC, liver-related complications (ascites, variceal bleeding), and liver-related death (or liver transplantation).
Three hundred seven chronic hepatitis C patients with bridging fibrosis (n = 127) or cirrhosis (n = 180) were evaluated by Cox regression analysis. Sustained virological response (SVR) was defined as undetectable serum HCV RNA at 24 weeks after treatment.
SVR developed in 33% of patients. The SVR rates were not different between patients with bridging fibrosis (37%) and those with cirrhosis (30%), p = 0.186. During a median follow-up of 3.5 years (range 1�18 years) after the last treatment, the incidence rates per 100 person-years of HCC, liver-related complications, and liver-related death, were 1.24, 0.62, and 0.61 among SVR patients, respectively, and 5.85, 4.16, and 3.76 among non-SVR patients, respectively (log-rank test, p < 0.001). According to multivariate analysis, non-SVR was an independent predictor of HCC (HR 3.06; 95% CI = 1.12�8.39), liver-related complications (HR 4.73; 95% CI: 1.09�20.57), and liver-related death (HR 3.71; 95% CI = 1.05�13.05).
SVR is achieved in one-third of patients with HCV-related cirrhosis treated with peginterferon and ribavirin. SVR has a strong independent positive influence on the incidence of HCC and on the prognosis of these patients.