Extrahepatic Malignancy Among Patients With Chronic Hepatitis C After Antiviral Therapy: A Real-World Nationwide Study on Taiwanese Chronic Hepatitis C Cohort (T-COACH)

Abstract

INTRODUCTION: Chronic hepatitis C virus (HCV) infection is associated with nonhepatocellular carcinoma malignancies. We aimed to evaluate whether achieving a sustained virological response (SVR, defined as HCV RNA seronegativity throughout posttreatment 24-week follow-up) could reduce the risk of non–hepatocellular carcinoma malignancy in a real-world nationwide Taiwanese Chronic Hepatitis C Cohort (T-COACH). METHODS: A total of 10,714 patients with chronic hepatitis C who had received interferon-based therapy (8,186 SVR and 2,528 non-SVR) enrolled in T-COACH and were linked to the National Cancer Registry database for the development of 12 extrahepatic malignancies, including those with potential associations with HCV and with the top-ranking incidence in Taiwan, over a median follow-up period was 3.79 years (range, 0–16.44 years). RESULTS: During the 44,354 person-years of follow-up, 324 (3.02%) patients developed extrahepatic malignancies, without a difference between patients with and without SVR (annual incidence: 0.69% vs 0.87%, respectively). Compared with patients with SVR, patients without SVR had a significantly higher risk of gastric cancer (0.10% vs 0.03% per person-year, P = 0.004) and non-Hodgkin lymphoma (NHL) (0.08% vs 0.03% per person-year, respectively, P = 0.03). When considering death as a competing risk, non-SVR was independently associated with gastric cancer (hazard ratio [HR]/95% confidence intervals [CIs]: 3.29/1.37–7.93, P = 0.008). When patients were stratified by age, the effect of SVR in reducing gastric cancer (HR/CI: 0.30/0.11–0.83) and NHL (HR/CI: 0.28/0.09–0.85) was noted only in patients aged <65 years but not those aged >65 years. DISCUSSION: HCV eradication reduced the risk of gastric cancer and NHL, in particular among younger patients, indicating that patients with chronic hepatitis C should be treated as early as possible.

Chronic Hepatitis Virus Infection Are Associated With High Risk of Gastric Cancer: A Systematic Review and Cumulative Analysis

“…Based on the NOS, three included studies ( 13 , 19 , 24 ) were considered to be moderate quality and 10 included studies ( 11 , 15 – 18 , 20 – 23 , 25 ) were high quality. The proportion of high methodological quality study was 76.9% (10/13).…”

“…Among these studies, 14 studies were eliminated for lacking control group, 11 studies did not meet the inclusion criteria, 12 studies for inappropriate grouping; 10 studies were excluded due to insufficient outcome data, and 1 study was eliminated for its study design was cross-sectional. Finally, 13 studies (11,13,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) met the aforementioned inclusion criteria and thus were included in this pooled analysis. Of which, two included studies (16,22) have provided the data of both HBV and HCV.…”

“…Of which, two included studies (16,22) have provided the data of both HBV and HCV. As a result, 10 included studies reporting HBV (13,(15)(16)(17)(18)(19)(20)(21)(22)(23) and five included studies (11,16,22,24,25) reporting HCV were used for pooling the overall HR.…”

Long‐term risk of end‐stage renal diseases with maintenance dialysis among chronic hepatitis C patients after antiviral therapy in Taiwan

“…Taiwanese Chronic Hepatitis C Cohort) enrolled 15 836 CHC patients from 23 regional hospitals and medical centers between January 2003 and December 2015. 12,13 It encountered 21% of over 75 000 CHC-treated population in Taiwan Health Insurance administration (https://data.nhi.gov.tw/). The inclusion criteria were (i) age > 20 years, (ii) CHC patients diagnosed by liver histology or anti-HCV seropositive for > 6 months, (iii) seropositive for HCV RNA, and (iv) patients had received IFN-based therapy for at least 4 weeks.…”

Itemization difference of patient-reported outcome in patients with chronic liver disease

“…Taiwan has a high prevalence of both viral hepatitis infections and NAFLD. The estimated prevalence of NAFLD was >40% in Taiwanese community-based studies, whilst the prevalence of chronic hepatitis B (CHB) and CHC reached 12-15%, and 4-9%, respectively [1,[10][11][12]. Therefore, the unique background thus provides an excellent field to assess the difference of HRQoL in patients with different etiologies [13].…”