Diabetes Mellitus Increases the Risk of Hepatocellular Carcinoma After Direct-Acting Antiviral Therapy: Systematic Review and Meta-Analysis

Váncsa, Szilárd; Németh, Dávid; Hegyi, Péter; Farkas, A.; Kiss, Szabolcs; Kanjo, Anna; Patrícia, Silvia; Pár, Gabriella

doi:10.3389/fmed.2021.744512

Cited by 12 publications

(17 citation statements)

References 59 publications

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“… 20 , 21 , 22 According to the recent meta‐analysis conducted by Vancsa et al ., DM increases the risk of HCC development after SVR following DAA treatment of HCV patients. 6 In this manuscript, Vancsa et al . concluded that there is a two‐way association between HCV infection and DM.…”

Section: Discussionmentioning

confidence: 92%

“…The risk of de novo hepatocellular carcinoma (HCC) in patients who achieve a sustained virologic response (SVR), through treatment with interferon or DAA, is known to be reduced. 3 , 4 , 5 , 6 Extrahepatic manifestations such as cryoglobulinemic vasculitis, lymphoma, cardiovascular diseases, and diabetes mellitus (DM) are recognized as a feature of HCV infection and can influence the morbidity, quality of life, and mortality of these patients. Several studies have shown a close link between viral eradication and a lower risk of extrahepatic manifestations, as well as an improvement of existing extrahepatic diseases.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for liver‐related mortality of patients with hepatitis C virus after sustained virologic response to direct‐acting antiviral agents

et al. 2022

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Background and Aim The aim of this study was to identify the factors associated with liver‐related and non‐liver‐related mortality of patients with hepatitis C virus (HCV) after sustained virologic response (SVR) to direct‐acting antiviral agents (DAAs). Methods We conducted a retrospective, single‐center cohort study of HCV patients cured by DAAs. Results A total of 330 patients with SVR to DAAs were eligible. The median follow‐up period was 3.38 years (inter‐quartile range: 2.03–4.58). The cumulative liver‐related or non‐liver‐related mortality rates at 1, 3, and 5 years were 0.00 or 1.29%, 2.87 or 3.60%, and 5.10 or 9.46, respectively. Among the liver‐related deaths, 9 of the 10 were from liver cancer. Among the non‐liver‐related deaths, the most common cause was malignancy. Through multivariate analysis using the Cox proportional hazard model, diabetes mellitus (DM, hazard ratio 13.1, 95% confidence interval 2.81–61.3) and a history of hepatocellular carcinoma (HCC, 12.8, 2.76–59.2), independently predicted liver‐related death. No variables were associated with non‐liver‐related death. Conclusion Our findings suggest that DM and a history of HCC are risk factors for liver‐related mortality of HCV patients cured by DAAs. These results indicate that early management of HCV and HCC surveillance of diabetic patients after SVR are important to increase the chance of survival. Further studies are needed to confirm the association of DM and HCC history with survival.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Risk factors for liver‐related mortality of patients with hepatitis C virus after sustained virologic response to direct‐acting antiviral agents

et al. 2022

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“…The 53 patients with a history of HCC were significantly older (75.6 years vs 66.5 years; P < 0.01) than the 258 patients with no history of HCC. The rates of diabetes, a risk factor for HCC after DAA treatment[ 20 ] (35.8% vs 3.1%; P < 0.01) and liver cirrhosis (34.0% vs 20.2%; P < 0.01) were significantly higher, whereas the rates of HCV genotype 2 (13.2% vs 25.6%; P = 0.04) were significantly lower, in patients with than without a history of HCC. In addition, serum albumin concentrations (3.5 g/dL vs 4.0 g/dL; P < 0.01) and platelet counts (12.9 × 10 4 /mL vs 16.7 × 10 4 /mL; P < 0.01) were significantly lower, whereas Fib-4 index (6.27 vs 3.37; P < 0.01) and AFP concentrations (23.7 ng/mL vs 9.4 ng/mL; P = 0.047) were significantly higher in patients who had a previous history of HCC.…”

Section: Resultsmentioning

confidence: 99%

Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

Tajiri¹,

Ito²,

Kawai³

et al. 2022

WJH

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BACKGROUND Hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients has a high risk of recurrence. Although eradication of HCV is expected to reduce this risk, the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals (DAAs). AIM To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC. METHODS The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals. The frequency and predictors of HCC recurrence/ occurrence after DAA treatment were included in these analyses. The clinical course of HCC before and after DAA treatment was also evaluated. RESULTS HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC. Median recurrence-free survival (RFS) was 1092 d in patients with a history of HCC, and post-DAA HCC recurrence/occurrence was observed in 29 patients (53.7%) with and 5 (1.9%) without a history of HCC over 6 years ( P < 0.001). RFS in patients with a history of HCC did not differ significantly before and after DAA treatment. The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment. Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment. Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy. CONCLUSION DAA therapy in patients infected with HCV is also effective in patients with a history of HCC. Curative treatment for HCC is desirable before DAA therapy. The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy. Careful observation after DAA therapy is required in patients with a history of HCC.

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“…(8) Independent of the presence of cirrhosis or the cause of the underlying liver disease, patients with diabetes have a 2-to 3-fold higher risk of developing HCC than individuals without diabetes. (9)(10)(11)(12)(13)(14)(15)(16)(17) A longer duration of diabetes may also be associated with an incremental increase in the risk of HCC, (18)(19)(20) and diabetes is an independent risk factor associated with reduced overall survival and disease-free survival in patients with HCC. (14,21,22) In addition, the proportion of diabetes among patients with HCC of nonviral etiology has continued to increase considerably during the last two decades.…”

Section: Introductionmentioning

confidence: 99%

Development and prognosis of hepatocellular carcinoma in patients with diabetes

Nakatsuka

Tateishi

2023

Clin Mol Hepatol

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Hepatocellular carcinoma (HCC); hepatitis B virus (HBV); hepatitis C virus (HCV); nonalcoholic liver disease (NAFLD); nonalcoholic steatohepatitis (NASH); type 2 diabetes (T2DM); model for end-stage liver disease (MELD); hazard ratio (HR); confidence interval (CI); alanine aminotransferase (ALT); odds ratio (OR); relative ratio (RR); insulin-like growth factor (IGF); phosphoinositide-3-kinase (PI3K); area under the receiver operating characteristics HCC in patients with diabetes 2 curve (AUROC); aspartate aminotransferase (AST); dipeptidyl peptidase-4 (DPP-4); glucagonlike peptide-1 (GLP-1); sodium-glucose cotransporter 2 (SGLT2).

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Diabetes Mellitus Increases the Risk of Hepatocellular Carcinoma After Direct-Acting Antiviral Therapy: Systematic Review and Meta-Analysis

Cited by 12 publications

References 59 publications

Risk factors for liver‐related mortality of patients with hepatitis C virus after sustained virologic response to direct‐acting antiviral agents

Risk factors for liver‐related mortality of patients with hepatitis C virus after sustained virologic response to direct‐acting antiviral agents

Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

Development and prognosis of hepatocellular carcinoma in patients with diabetes

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