Wayne State University / Detroit Medical Center Detroit, MI
Introduction: Chronic Hepatitis C Virus (HCV) infection can lead to liver cirrhosis and is a major cause of Hepatocellular Carcinoma (HCC) in the United States. Direct acting antiviral (DAA) therapies revolutionized HCV treatment by increasing the SVR of African Americans (AA) with HCV from 25% with interferon to greater than 95%. We hypothesized that our predominately AA medical center population would demonstrate a reduction in HCV-driven HCC diagnosis secondary to the initiation of DAA-mediated treatment beginning in 2014.
Methods: The patient dataset used ICD-9/10 codes for HCC as the primary diagnosis from 2010 to 2021. We excluded patients with a diagnosis prior to 2009, those seeking a second opinion, patients without accurate tumor measurement and confirmation of HCC, patients with only tumor measurement but no follow-up and patients with rare risk factors. SAS/JMP was used for statical analysis with ANOVA for numeric variables and Pearson chi-square for character variables.
Results: There were 465 HCC patients of whom 437 had self-identified race in the database (AA=353; Non-AA= 84). There was no difference in gender or age between both race groups with HCV as the dominant risk factor (Table 1). Non-AA patients were less likely to have an identified risk factor (cryptogenic) as compared to AA patients. There was a statistically significant difference between the prevalence of HCV in AA (85%) compared to Non-AA (53%) patients. When the diagnosis of HCC was evaluated between the years of 2009 and 2021, even in 2009, there was a significant proportion of the patients with HCV as the risk factor (Figure 1). There was a notable increase in HCC to a peak in 2017 corresponding to an increase in the number of HCC patients with HCV. The subsequent decline through 2021 corresponded to a decrease in patients with HCV as the primary risk factor for HCC. The number of patients without HCV as risk factor was similar throughout the period between 2009 and 2021. This observation was also seen when both groups were compared.
Discussion: There was a significant increase in the number of patients with HCC diagnosed in our medical center prior to 2018 and a significant decrease between 2018 and 2021. Although observational data cannot prove causation, the introduction of DAA therapies to treat HCV in 2014 is indirect evidence that such therapy is responsible for the reduction in HCC cases.
