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931 PREDICTION OF LONG-TERM SURVIVAL IN CHRONIC HEPATITIS C PATIENTS WITH ADVANCED FIBROSIS USING STANDARD LABORATORY TESTS
POSTERS 931 PREDICTION OF LONG-TERM SURVIVAL IN CHRONIC HEPATITIS C PATIENTS WITH ADVANCED FIBROSIS USING STANDARD LABORATORY TESTS A.J.P. van der Meer1 , B.E. Hansen2 , J.J. Feld3 , H. Wedemeyer4 , J.-F. Dufour5 , F. Lammert6 , A. Duarte-Rojo3 , M.P. Manns4 , L. Kuske5 , S. Zeuzem7 , W.P. Hofmann7 , R.J. de Knegt2 , B.J. Veldt2 , H.L.A. Janssen2 . 1 Department of Gastroenterology and Hepatology, 2 Department of Gastroenterology & Hepatology, Erasmus MC, Rotterdam, The Netherlands; 3 Liver Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 4 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany; 5 Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland; 6 Department of Medicine II, Saarland University Medical Center, Homburg/Saar, 7 Medizinische Klinik 1, Klinikum der J.W. Goethe-Universit¨ at, Frankfurt am Main, Germany E-mail: [email protected] Introduction: Liver-related morbidity and mortality is rare after achieving sustained virological response (SVR) in chronic hepatitis C (CHC) patients with advanced fibrosis, whereas disease progression varies in patients who are not cured. The aim of this study is to predict the long-term survival in CHC patients with advanced fibrosis who did not achieve SVR, using standard laboratory tests. Methods: We assessed the survival in our previously described multicenter cohort of CHC patients from 5 large tertiary care hospitals in Europe and Canada. All consecutive patients with biopsy-proven advanced fibrosis or cirrhosis (Ishak 4–6) were included from their first interferon-based treatment between 1990 and 2003. Follow-up was completed up to 2010, if needed also by recontacting the patient or the general physician. Results: In total 530 patients were included, of which 405 (76%) had failed to achieve SVR on baseline treatment. Among the non-SVR patients the median age was 48 years (IQR 42–56), 275 (68%) were male and 290 (76%) had genotype 1. The Ishak fibrosis score was 4 in 105 patients (26%), 5 in 75 (19%) and 6 in 225 (57%). The median follow-up duration in non-SVR patients was 8.1 years (IQR 5.7–11.1), during which a total of 100 patients (25%) died. Multivariate Cox regression analyses, in 305 representative patients with available laboratory markers of disease severity, showed platelet count (HR 0.99, 95% CI 0.99–1.00, p < 0.001), log transformed AST/ALT ratio (HR 7.74, 95% CI 1.73–34.58, p = 0.007) and age (HR 1.06, 95% CI 1.03–1.08, p < 0.001) to be significantly associated with all-cause mortality. A prediction score based on these 3 variables showed a 10-year survival of 94% in the lowest compared to 53% in the high risk group (lowest and highest quartile of patients, respectively, p < 0.001, Figure).
Figure: Prediction of survival, based on platelet count, AST/ALT ratio and age.
Conclusion: The overall survival of CHC patients with advanced fibrosis who fail to achieve SVR can be straightforwardly determined based on the platelet count, AST/ALT ratio and age. 932 FACTORS ASSOCIATED WITH HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS C PATIENTS WITH ADVANCED LIVER FIBROSIS A.J.P. van der Meer1 , B.E. Hansen1 , J.J. Feld2 , H. Wedemeyer3 , J.-F. Dufour4 , F. Lammert5 , A. Duarte-Rojo2 , M.P. Manns3 , L. Kuske4 , S. Zeuzem6 , W.P. Hofmann6 , R.J. de Knegt1 , B.J. Veldt1 , H.L.A. Janssen1 . 1 Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands; 2 Liver Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 3 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany; 4 Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland; 5 Department of Medicine II, Saarland University Medical Center, Homburg/Saar, 6 Medizinische Klinik 1, Klinikum der J.W. Goethe-Universit¨ at, Frankfurt am Main, Germany E-mail: [email protected] Introduction: Hepatocellular carcinoma (HCC) is a frequent complication in chronic hepatitis C (CHC) patients with advanced liver disease. The aim of this study was to identify factors associated with HCC in CHC patients with advanced liver fibrosis. Methods: We assessed the occurrence of HCC in our previously described multicenter cohort of HCV patients from 5 large tertiary care hospitals in Europe and Canada. All consecutive patients with biopsy-proven advanced fibrosis or cirrhosis (Ishak 4–6) were included from their first interferon-based treatment between 1990 and 2003. Follow-up was completed up to 2010, if needed also by recontacting the patient or the general physician. Results: Five hundred and thirty patients were followed for a median of 8.4 years (IQR 6.4–11.4). The median age was 48 years (IQR 42–57), 340 (68%) had genotype 1. The Ishak fibrosis score was 4 in 143 patients (27%), 5 in 101 (19%), and 6 in 286 (54%). In total 192 (36%) patients achieved sustained virological response (SVR). Seventy-six non-SVR patients (22%) were diagnosed with HCC and 7 SVR patients (4%) up to 6.7 years after viral clearance. Timedependent multivariate Cox regression analyses showed that SVR was associated with a substantially lower risk for the occurrence of HCC compared to non-SVR (HR 0.20, 95% CI 0.09–0.46, p < 0.001, Figure). Among the non-SVR patients, age (HR 1.09, 95% CI 1.05– 1.12, p < 0.001), presence of cirrhosis (HR 3.07, 95% CI 1.37–6.90, p = 0.007), positive history for severe alcohol use (HR 2.23, 95% CI 1.21–4.13, p = 0.011) and presence of diabetes mellitus at baseline (HR 2.30, 95% CI 1.17–4.52, p = 0.015) were significantly associated with HCC occurence. Next to the above mentioned factors, males (HR 2.14, 95% CI 1.05–4.38, p = 0.037) and patients with hepatitis C genotype 3 (HR 3.12, 95% CI 1.45–6.72, p = 0.004) demonstrated a significantly increased risk of HCC in non-SVR patients with liver cirrhosis.
Graph: Incidence of HCC in follow-up of a multicenter HCV patient cohort.
Journal of Hepatology 2012 vol. 56 | S225–S388
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Figure: Prediction of survival, based on platelet count, AST/ALT ratio and age.
Conclusion: The overall survival of CHC patients with advanced fibrosis who fail to achieve SVR can be straightforwardly determined based on the platelet count, AST/ALT ratio and age. 932 FACTORS ASSOCIATED WITH HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS C PATIENTS WITH ADVANCED LIVER FIBROSIS A.J.P. van der Meer1 , B.E. Hansen1 , J.J. Feld2 , H. Wedemeyer3 , J.-F. Dufour4 , F. Lammert5 , A. Duarte-Rojo2 , M.P. Manns3 , L. Kuske4 , S. Zeuzem6 , W.P. Hofmann6 , R.J. de Knegt1 , B.J. Veldt1 , H.L.A. Janssen1 . 1 Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands; 2 Liver Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 3 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany; 4 Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland; 5 Department of Medicine II, Saarland University Medical Center, Homburg/Saar, 6 Medizinische Klinik 1, Klinikum der J.W. Goethe-Universit¨ at, Frankfurt am Main, Germany E-mail: [email protected] Introduction: Hepatocellular carcinoma (HCC) is a frequent complication in chronic hepatitis C (CHC) patients with advanced liver disease. The aim of this study was to identify factors associated with HCC in CHC patients with advanced liver fibrosis. Methods: We assessed the occurrence of HCC in our previously described multicenter cohort of HCV patients from 5 large tertiary care hospitals in Europe and Canada. All consecutive patients with biopsy-proven advanced fibrosis or cirrhosis (Ishak 4–6) were included from their first interferon-based treatment between 1990 and 2003. Follow-up was completed up to 2010, if needed also by recontacting the patient or the general physician. Results: Five hundred and thirty patients were followed for a median of 8.4 years (IQR 6.4–11.4). The median age was 48 years (IQR 42–57), 340 (68%) had genotype 1. The Ishak fibrosis score was 4 in 143 patients (27%), 5 in 101 (19%), and 6 in 286 (54%). In total 192 (36%) patients achieved sustained virological response (SVR). Seventy-six non-SVR patients (22%) were diagnosed with HCC and 7 SVR patients (4%) up to 6.7 years after viral clearance. Timedependent multivariate Cox regression analyses showed that SVR was associated with a substantially lower risk for the occurrence of HCC compared to non-SVR (HR 0.20, 95% CI 0.09–0.46, p < 0.001, Figure). Among the non-SVR patients, age (HR 1.09, 95% CI 1.05– 1.12, p < 0.001), presence of cirrhosis (HR 3.07, 95% CI 1.37–6.90, p = 0.007), positive history for severe alcohol use (HR 2.23, 95% CI 1.21–4.13, p = 0.011) and presence of diabetes mellitus at baseline (HR 2.30, 95% CI 1.17–4.52, p = 0.015) were significantly associated with HCC occurence. Next to the above mentioned factors, males (HR 2.14, 95% CI 1.05–4.38, p = 0.037) and patients with hepatitis C genotype 3 (HR 3.12, 95% CI 1.45–6.72, p = 0.004) demonstrated a significantly increased risk of HCC in non-SVR patients with liver cirrhosis.
Graph: Incidence of HCC in follow-up of a multicenter HCV patient cohort.
Journal of Hepatology 2012 vol. 56 | S225–S388
S363