Extrahepatic Malignancy Among Patients With Chronic Hepatitis C After Antiviral Therapy: A Real-World Nationwide Study on Taiwanese Chronic Hepatitis C Cohort (T-COACH)
Chung‐Feng Huang, Hsueh‐Chou Lai, Chi-Yi Chen, Kuo‐Chih Tseng, Hsing‐Tao Kuo, Chao‐Hung Hung, Jing‐Houng Wang, Jyh-Jou Chen, Pei-Lun Lee, Rong‐Nan Chien, Chi-Chieh Yang, Gin‐Ho Lo, Chi‐Ming Tai, Chih‐Wen Lin, Jia‐Horng Kao, Chun‐Jen Liu, Chen‐Hua Liu, Sheng-Lei Yan, Ming‐Jong Bair, Chun‐Yen Lin, Wei‐Wen Su, Cheng-Hsin Chu, Chih-Jen Chen, Shui‐Yi Tung, Gin‐Ho Lo, Pin‐Nan Cheng, Yen‐Cheng Chiu, Chia‐Chi Wang, Jin-Shiung Cheng, Wei-Lun Tsai, Han‐Chieh Lin, Yi‐Hsiang Huang, Ming‐Lun Yeh, Jee‐Fu Huang, Chia‐Yen Dai, Wan‐Long Chuang, Pei‐Chien Tsai, Cheng‐Yuan Peng, Ming‐Lung Yu
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.