Lamivudine treatment in patients with HBV-related hepatocellular carcinoma--using an untreated, matched control cohort.

Lamivudine is widely used to treat patients with hepatitis B. However, the outcomes in patients with hepatocellular carcinoma (HCC) treated with lamivudine have not been established. This study was conducted to evaluate the outcomes of lamivudine treatment for patients with HCC using an untreated, matched control group. Thirty patients with controlled HCC orally received lamivudine. As controls, 40 patients with HCC who were not treated with lamivudine and matched for clinical features were selected. The lamivudine-treated and untreated groups were compared with respect to changes in liver function, HCC recurrence, survival, and cause of death. In the lamivudine-treated group, there was significant improvement in the Child-Pugh score at 24 months after starting treatment, while no improvement was observed in the untreated group. There was no significant difference in the cumulative incidence of HCC recurrence and survival between the groups. However, there was a significant difference in the cumulative incidence of death due to liver failure (P= 0.043). A significant improvement in liver function was achieved by lamivudine treatment, even in patients with HCC. These results suggest that lamivudine treatment for patients with HCC may prevent death due to liver failure. Further prospective randomized studies using a larger number of patients are required.</p

Hepatocellular carcinoma recurrence in HCV patients treated with direct-acting antivirals after curative treatment

Aim: The increased risk of hepatocellular carcinoma (HCC) recurrence in hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAAs) after curative treatment for HCC is controversial. The purpose of this study was to examine the risk of HCC recurrence after DAA therapy.Methods: We conducted a retrospective cohort study of 312 consecutive patients with HCV-related HCC who received DAA therapy in participating institutions between September 2014 and July 2016. All patients received curative hepatectomy or radio-frequency ablation. We calculated the annual incidence of HCC recurrence after DAA therapy and identified the risk factors for HCC recurrence using Cox regression models.Results: The median age was 74 years old, and a sustained virological response was achieved by 288 patients. The 3-year-overall survival rate was 95.4% in a median follow-up period of 855 days. HCC recurred in 135 patients. The 1-, 2- and 3-year recurrence rates were 18.3%, 38.8% and 55.4%, respectively. A multivariate analysis revealed that the following factors were associated with HCC recurrence: multiple tumors at the first HCC treatment [hazard ratio (HR) = 2.21; 95%CI: 1.41-3.49], a history of multiple treatments for HCC (HR = 1.97; 95%CI: 1.28-3.02), and α-fetoprotein (AFP-L3) ≥ 10% at the initiation of DAA therapy (HR = 4.74; 95%CI: 2.10-10.7).Conclusion: Among patients treated with DAAs after the curative treatment of HCC, multiple tumors at the first HCC treatment, multiple prior HCC treatments and a high AFP-L3 level before DAA therapy were associated with recurrence, and the rate of recurrence was comparable to that before the DAA era

Association of soluble T cell immunoglobulin domain and mucin-3 (sTIM-3) and mac-2 binding protein glycosylation isomer (M2BPGi) in patients with autoimmune hepatitis.

BackgroundAutoimmune hepatitis (AIH) is a disorder of unknown etiology in which immune-mediated liver injury progress to cirrhosis or hepatocellular carcinoma (HCC). The aim of the present study was to determine whether circulating soluble TIM3 (sTIM3) is elevated in patients with AIH patients and whether sTIM-3 levels are associated with clinical parameters of AIH.MethodsWe enrolled 123 Japanese patients with AIH who were identified from the National Hospital Organization-AIH-liver-network database, as well as 32 patients with chronic hepatitis C (CHC), 30 patients with primary biliary cholangitis (PBC) and healthy control subjects. Serum sTIM-3 concentrations were quantified by ELISA.ResultsSerum levels of sTIM-3 were significantly higher in AIH patients (median 4865 pg/ml; [interquartile range (IQR); 3122-7471]) compared to those in CHC (1026 pg/ml [IQR: 806-1283] pConclusionsCirculating sTIM-3 levels were elevated in AIH patients and are associated with AIH disease activity and AIH-related liver damage. These findings indicate that serum sTIM-3 correlated with disease status of AIH and could be useful biomarkers to detect autoimmune-mediated liver injury. Our data suggest a possible link between the TIM-3/GAL-9 pathway and AIH severity or phenotype, and further investigations of the TIM-3 pathway and AIH pathophysiology is warranted