title: Hepatic decompensation is the major driver of death in HCV-infected cirrhotic patients with successfully treated early hepatocellular carcinoma.
abstract: Assessment of long-term outcome is required in hepatitis C virus (HCV)-infected patients with cirrhosis, who have been successfully treated for Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC). However, problems arise due to the lack of models accounting for early changes during follow-up. The aim of this study was to estimate the impact of early events (HCC recurrence or hepatic decompensation within 12months of complete radiological response) on 5-year overall survival (OS) in a large cohort of patients with HCV and cirrhosis, successfully treated HCC.
  
  
  
  A total of 328 consecutive Caucasian patients with HCV-related cirrhosis and BCLC stage 0/A HCC who had complete radiological response after curative resection or thermal ablation were prospectively recruited to this study. Primary endpoint of the study was 5-year OS. Independent baseline and time-dependent predictors of 5-year OS were identified by Cox model.
  
  
  
  The observed 5-year survival rate was 44%. The observed HCC early recurrence and early hepatic decompensation rate were 21% and 10%, respectively. Early hepatic decompensation (Hazard Ratio [HR] 7.52; 95% confidence intervals (CI): 1.23-13.48) and HCC early recurrence as time-dependent covariates (HR 2.50; 95%CI: 1.23-5.05), presence of esophageal varices at baseline (HR 1.66; 95% CI: 1.02-2.70) and age (HR 1.04; 95% CI: 1.02-1.07) were significantly associated with the 5-year OS.
  
  
  
  Survival in HCV-infected patients with cirrhosis and successfully treated HCC is influenced by early hepatic decompensation. Our study indirectly suggests that direct-acting antiviral agents could improve OS of HCC patients through long-term preservation of liver function, resulting in a lower cirrhosis-related mortality and a greater change of receiving curative treatments.
  
  
  
  Survival in hepatitis C virus (HCV) infected patients with cirrhosis and successfully treated hepatocellular carcinoma (HCC), is mainly influenced by early hepatic decompensation. HCV eradication after treatment with new direct-acting antiviral agents could improve overall survival of HCC patients through long-term preservation of liver function.
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbara
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Attardo
authors.affiliation: Department of Medical and Surgical Sciences Semeiotica Medica, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bucci
authors.affiliation: Section of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Gastroenterology Unit, Department Internal Medicine, University of Genoa, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Negrini
authors.affiliation: Surgery Unit, Policlinico San Marco, Zingonia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Division of Medicine, Bolognini Hospital, Seriate, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Marco
authors.affiliation: Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Division of Radiology, Department of Medicine, Fatebenefratelli Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.affiliation: Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
authors.affiliation: Division of Gastroenterology, Department of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mega
authors.affiliation: Departiment of Clinical and Experimental Medicine, Medical Unit, University of Padua, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Division of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.affiliation: Division of Gastroenterology, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Svegliati-Baroni
authors.affiliation: Division of Infectious Diseases and Hepatology, Parma University Hospital, Parma, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Foschi
authors.affiliation: Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Olivani
authors.affiliation: Department of Clinical Medicine and Surgery, Hepatogastroenterology Unit, University Federico II, Naples, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Masotto
authors.affiliation: Internal Medicine Unit, University of Salerno, Salerno, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nardone
authors.affiliation: Department of Medical and Surgical Sciences Semeiotica Medica, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Persico
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Department of Medical and Surgical Sciences Semeiotica Medica, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.affiliation: Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy. Electronic address: calogero.camma@unipa.it.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models
keywords: Antiviral agents; Carcinoma, hepatocellular; Hepatic decompensation; Hepatitis C; Hepatocellular carcinoma (HCC); Liver cirrhosis; Overall survival; Prognosis; Recurrences; Survival rate; Sustained virological response