Hepatitis C and hepatocellular carcinoma: New developments in natural history and treatment

The incidence of hepatocellular carcinoma (HCC) associated with chronic hepatitis C virus (HCV) infection doubled over the past 20 years in the United States because of an increase in cirrhosis related to HCV and other factors, including diabetes mellitus. Survival after HCC diagnosis remains relatively unchanged, with a persistently high mortality rate. Primary prevention of HCC by treatment of HCV is supported by multiple, large, retrospective studies. Despite significant methodologic limitations, the studies indicate a benefit of HCC reduction with therapy. Sustained virologic response appears to provide the greatest protection against HCC development. Alternatively, a large, randomized, controlled trial showed that maintenance HCV treatment in patients with advanced fibrosis and cirrhosis does not decrease HCC incidence. Secondary prevention of HCC in HCV patients with established HCC who have undergone primary resection or liver-directed therapy appears beneficial only in reducing the risk of late HCC recurrence.