The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.

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KEYWORDSChronic hepatitis C infection; PEG-interferon and ribavirin combination therapy; Rapid virological response; Sustained virological response Summary Backgrounds: Pegalated interferon (PEG-IFN) combination with ribavirin (RBV) (PR) in accordance to response-guide therapy (RGT) is a treatment option for chronic hepatitis C (CHC) in the past decade. Baseline host and viral factors and early viral kinetics are important determinants for patient using combination therapy. Aims: We aimed to investigate the effects of host and viral factors on sustained virus response (SVR). We researched the possible predictors of an SVR. Methods: We retrospectively analyzed a total of 158 CHC patients who had been treated with a PR dual therapy. Clinical parameters and virological responses were analyzed for their relationship with SVR. Results: The overall SVR rate was 71.5% (113/158). Factors associated with an SVR were ALT levels＞ 3xULN, non-AST/ALT＞1, non-genotype 1 and non-cirrhosis. Non-genotype 1 (OR: 3.154; 95% CI: 1.309-7.601; P = 0.010), and non-cirrhosis (OR: 2.696; 95% CI: 1.045-6.956; P = 0.004) were the predictors of an SVR. An SVR significantly increased in patients with an RVR and significantly reduced in patients with cEVR, pEVR, null response and relapse. In addition, an RVR was a powerful independent predictor of an SVR (OR: 38.263; 95% CI: 10.184-143.757; P = 0.000). The positive predictive value (PPV) of an RVR on SVR was 92.2% (94/102).

Patients with chronic hepatitis C‐associated liver disease are of an older age in southern Taiwan. PEGylated interferon‐based therapy could reduce the risk of cirrhosis and hepatocellular carcinoma and improve survival. We assessed the efficacy and safety of combination therapy with PEGylated interferon plus ribavirin in elderly patients with chronic hepatitis C. A total of 88 consecutive patients with chronic hepatitis C treated with combination therapy were analyzed retrospectively to identify factors associated with a sustained virological response (SVR). These patients were divided into two groups according to age: elderly patients ≧ 60 years (n = 43) and patients 50 to 59 years (n = 45). We compared baseline characteristics, adherence 80/80/80, dose modification, discontinuation, and adverse events profiles between these two groups. We further compared virological response rates stratified by genotype. The factors associated with an SVR were determined by total patients and different age groups. In the intent‐to‐treat analysis, the SVR rate was 61.8%. The SVR rate of elderly patients tended to be superior to that of total patients. Patients aged ≧ 60 years had a higher proportion of concomitant chronic disease, dose modification, clinical events with anorexia, depression, leucopenia, and anemia than those aged 50 to 59 years. Total patients with genotype 1 tended to have a lower SVR rate than nongenotype 1 (P = 0.067). Total patients with nongenotype 1 had a significantly higher rapid virological response (RVR) rate than genotype 1 (P = 0.009). In patients aged ≧ 60 years, the relapse rate of genotype 1 was higher than that of nongenotype 1 (P = 0.034). After stratification by HCV genotype 1, high viral load, and achievement of an RVR, the SVR rates remained similar between the two groups. The most strongly predictive factors of an SVR of total patients were the achievement of an RVR (OR: 49.744; 95% CI: 6.979‐354.574; P < 0.001), followed by breakthrough (OR: 0.018; 95% CI: 0.002‐0.195; P = 0.001). The factor mostly predictive of an SVR in age ≧ 60 years group was achievement of an RVR (OR: 12.779; 1.430‐114.180; P = 0.023). Elderly patients had a greater frequency of adverse events. Genotype 1 is independently associated with lower SVR and RVR rates and high relapse rates. Attainment of an RVR is the most powerful predictor of SVR in elderly patients.