Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

Dima Dandachi; Manal Hassan; Ahmed Kaseb; Georgios Angelidakis; Harrys A Torres

doi:10.2147/JHC.S164568

Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

J Hepatocell Carcinoma. 2018 Aug 2:5:81-86. doi: 10.2147/JHC.S164568. eCollection 2018.

Authors

Dima Dandachi^{1

2}, Manal Hassan³, Ahmed Kaseb⁴, Georgios Angelidakis², Harrys A Torres^{2

4}

Affiliations

¹ Department of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA.
² Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, htorres@mdanderson.org.
³ Department of Epidemiology, The University of Texas Medical School, Houston, TX, USA.
⁴ Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, htorres@mdanderson.org.

Abstract

Introduction: Chronic hepatitis C virus (HCV) infection is one of the leading causes of hepatocellular carcinoma (HCC) worldwide. Antiviral therapy in patients with HCV infection reduces the risk of primary HCC development by 71%-75%. HCV-infected patients with different primary cancers are also at risk for HCC development as a second primary malignancy (HCC-SPM). Limited information is available on the occurrence and characteristics of HCC-SPM. Herein, we determine the prevalence and clinical features of HCV-associated HCC-SPM when compared to primary HCC.

Materials and methods: Patients with HCV-associated HCC seen at MD Anderson Cancer Center (2011-2017) were enrolled in a prospective observational study. Patients with multiple cancers diagnosed simultaneously or with hepatitis B virus or HIV coinfections were excluded. At enrollment, patients completed a questionnaire on medical history and HCC risk factors. Information on demographics, comorbidities, HCV treatment, tumor characteristics, treatment modalities, and virologic and oncologic outcomes were extracted from the medical records.

Results: Among 171 consecutive patients with HCV-associated HCC enrolled, 26 (15%) had HCC-SPM. Most of the underlying primary cancers were solid tumors (85%). In 12 (46%) of these patients, the diagnosis was made incidentally while undergoing surveillance for primary malignancies, and the majority (81%) had their primary cancer in remission. Most patients (72%) with documented HCV viral load had chronic viremia due to lack of diagnosis, lack of treatment, or prior unsuccessful treatment of HCV infection and only 28% had undetectable viral load following successful antiviral therapy. The overall median survival for both groups was 29 months (95% CI: 23-35) without difference between groups (p=0.2).

Conclusion: Cancer patients with any malignancies must be screened for HCV as HCC-SPM can develop in 15% of infected patients. Early HCV diagnosis and treatment should be attempted to prevent the development of HCC-SPM, a condition associated with high mortality in cancer survivors.

Keywords: DAA; HCV treatment; cancer prevention; cancer survivors; liver cancer.