Direct-acting antivirals improve survival and recurrence rates after treatment of hepatocellular carcinoma within the Milan criteria

Abstract Background The effects of direct-acting antivirals (DAAs) on survival and recurrence rates after curative hepatocellular carcinoma (HCC) treatment in patients with hepatitis C virus (HCV) infection remain controversial. Methods This retrospective, multicenter study involved Child–Pugh class A patients within the Milan criteria who had a first diagnosis of HCC and survived 6 months or longer after undergoing hepatectomy or radiofrequency ablation (RFA). The DAA-treated group (DAA group) included 56 patients, and the DAA-untreated group (untreated group) included 261 patients. The study was conducted using the propensity score-matched (1:2) DAA group and untreated group, 56 and 112 patients, respectively. Results The survival rate at 48 months in the DAA group and the untreated group was 91.0% and 68.7%, respectively, showing significantly better survival in the DAA group (HR: 0.33; 95% CI 0.13–0.84; p = 0.021). The recurrence rate at 48 months was 36.7% and 66.7%, respectively, showing a significantly lower recurrence rate in the DAA group (HR, 0.46; 95% CI 0.27–0.77; p = 0.003). The median albumin–bilirubin (ALBI) score at 3 years post-HCC treatment was − 2.84 in the DAA group and − 2.34 in the untreated group. The ALBI score showed a significant improvement from baseline to 3 years post-HCC treatment (p = 0.001), whereas that in the untreated group showed a significant decline (p = 0.040). Conclusions DAAs after HCC treatment prevents deterioration of hepatic functional reserve and significantly improves both recurrence and survival rates.

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Absence of differences in the recurrence rates of hepatitis C virus‑associated hepatocellular carcinoma between direct‑acting antivirals and interferon‑based treatments: A multicenter study

World Academy of Sciences Journal ◽

10.3892/wasj.2021.98 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Atsushi Nakazawa ◽

Shinichi Fujioka ◽

Kazuo Notsumata ◽

Toshihide Shima ◽

Kimihiko Yangita ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Multicenter Study ◽

Direct Acting Antivirals ◽

Recurrence Rates ◽

Direct Acting

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Survival and recurrence rates of hepatocellular carcinoma after treatment of chronic hepatitis C using direct acting antivirals

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001972 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Rania M. Lithy ◽

Tamer Elbaz ◽

Ahmed H. Abdelmaksoud ◽

Mohamed M. Nabil ◽

Noha Rashed ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Direct Acting Antivirals ◽

Recurrence Rates ◽

Direct Acting

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Long-Term Outcomes and Evaluation of Hepatocellular Carcinoma Recurrence after Hepatitis C Virus Eradication by Direct-Acting Antiviral Treatment: All Kagawa Liver Disease Group (AKLDG) Study

Cancers ◽

10.3390/cancers13092257 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2257

Author(s):

Joji Tani ◽

Tomonori Senoh ◽

Akio Moriya ◽

Chikara Ogawa ◽

Akihiro Deguchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Antiviral Treatment ◽

Survival Rates ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Virus Eradication ◽

Direct Acting Antiviral ◽

Direct Acting ◽

Hcc Recurrence

There are limited studies that have evaluated the long-term outcomes in patients with hepatocellular carcinoma (HCC) recurrence after direct-acting antiviral (DAA) treatment. In this retrospective study, we aimed to investigate the recurrence rates, recurrence factors, and prognosis of 130 patients who were treated with IFN-free DAA treatment after treatment for HCC. The median observation time was 41 ± 13.9 months after DAA treatment. The recurrence rates of HCC were 23.2%, 32.5%, 46.3%, and 59.4% at 6, 12, 24, and 36 months, respectively. A multivariate analysis showed that palliative treatment prior to DAA treatment (HR = 3.974, 95% CI 1.924–8.207, p = 0.0006) and alpha-fetoprotein at sustained virological response 12 (HR = 1.048, 95% CI 1.016–1.077, p = 0.0046) were associated with independent factors for HCC recurrence (HCC-R). The 12-, 24-, and 36-month overall survival rates were 97.6%, 94.0%, and 89.8%, respectively. The 12-, 24-, and 36-month survival rates of the non-recurrence and recurrence groups were 97.7%, 97.7%, and 94.1% and 97.6%, 92.3%, and 87.9%, respectively (p = 0.3404). The size of the main tumor lesion and the serological data were significantly improved at the time of HCC-R after DAA treatment. This study showed an improved prognosis regardless of recurrence rate, which suggests that DAA treatment in HCV patients should be considered.

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Accelerated hepatocellular carcinoma recurrence rate after postoperative direct-acting antivirals treatment – preliminary report

Clinical and Experimental Hepatology ◽

10.5114/ceh.2017.71483 ◽

2017 ◽

Vol 4 ◽

pp. 194-197 ◽

Cited By ~ 10

Author(s):

Karola Warzyszyńska ◽

Maurycy Jonas ◽

Dariusz Wasiak ◽

Maciej Kosieradzki ◽

Piotr Małkowski

Keyword(s):

Hepatocellular Carcinoma ◽

Recurrence Rate ◽

Preliminary Report ◽

Direct Acting Antivirals ◽

Hepatocellular Carcinoma Recurrence ◽

Direct Acting

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Postoperative adjuvant transarterial chemoembolization improves the prognosis of hepatocellular carcinoma patients with microvascular invasion: a systematic review and meta-analysis

Acta Radiologica ◽

10.1177/0284185119878357 ◽

2019 ◽

Vol 61 (6) ◽

pp. 723-731

Author(s):

Lian Li ◽

Bo Li ◽

Ming Zhang

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Recurrence Rate ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Survival Rates ◽

Microvascular Invasion ◽

Recurrence Rates ◽

The One ◽

Overall Survival Rates

Background Microvascular invasion has been widely accepted as a major risk factor of hepatocellular carcinoma prognoses after surgery. It is still controversial whether postoperative adjuvant transarterial chemoembolization could improve the survival of hepatocellular carcinoma patients with microvascular invasion. Purpose To evaluate the effect of postoperative adjuvant transarterial chemoembolization for postoperative hepatocellular carcinoma patients with microvascular invasion. Material and Methods PubMed, Web of Science, and Embase databases were searched for eligible studies, and the one-, three-, and five-year recurrence rates and overall survival rates were extracted for meta-analysis. Results A total of eight studies were included in this study. The results showed that the one-, three-, and five-year recurrence rate of the postoperative adjuvant transarterial chemoembolization group were better than those of the hepatectomy alone group, with a pooled risk ratio (RR) of 0.66 (95% confidence interval [CI] 0.58–0.75, P < 0.00001), 0.82 (95% CI 0.76–0.88, P < 0.00001), and 0.89 (95% CI 0.82–0.97, P = 0.007), respectively. The overall survival rates with one-, three-, and five-year pooled RR were 0.34 (95% CI 0.25–0.47, P < 0.00001), 0.69 (95% CI 0.60–0.79, P < 0.00001), and 0.78 (95% CI 0.69–0.89, P = 0.0001), respectively. No serious side effects have been reported, indicating that postoperative intervention is safe. Conclusion For hepatocellular carcinoma patients with microvascular invasion confirmed by postoperative pathology, postoperative adjuvant transarterial chemoembolization is a safe treatment, which could reduce the tumor recurrence rate and improve the patient’s overall survival.

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Faculty Opinions recommendation of Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct-acting antivirals.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726468907.793521728 ◽

2016 ◽

Author(s):

Doug Dieterich ◽

Dost Sarpel

Keyword(s):

Hepatocellular Carcinoma ◽

Direct Acting Antivirals ◽

Direct Acting ◽

Early Occurrence

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FRI-496-Recurrence of hepatocellular carcinoma in patients with complete response treated with direct acting antivirals in clinical practice

Journal of Hepatology ◽

10.1016/s0618-8278(19)31231-9 ◽

2019 ◽

Vol 70 (1) ◽

pp. e617

Author(s):

Christie Perelló ◽

Elba Llop ◽

Inmaculada Fernández Vázquez ◽

Ana M Matilla ◽

Francisco Gea ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Clinical Practice ◽

Complete Response ◽

Direct Acting Antivirals ◽

Direct Acting

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Direct-acting antivirals and recurrence of hepatocellular carcinoma

Liver Transplantation ◽

10.1002/lt.24822 ◽

2017 ◽

Vol 23 (9) ◽

pp. 1099-1100 ◽

Cited By ~ 1

Author(s):

Jorge A. Marrero ◽

Amit G. Singal

Keyword(s):

Hepatocellular Carcinoma ◽

Direct Acting Antivirals ◽

Direct Acting

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Hepatocellular Carcinoma Risk According to Regimens for Eradication of Hepatitis C Virus; Interferon or Direct Acting Antivirals

Cancers ◽

10.3390/cancers12113414 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3414

Author(s):

Hye Won Lee ◽

Dai Hoon Han ◽

Hye Jung Shin ◽

Jae Seung Lee ◽

Seung Up Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Pegylated Interferon ◽

Direct Acting Antivirals ◽

Treatment Regimens ◽

Direct Acting ◽

Similar Risk ◽

Carcinoma Risk

By pegylated interferon (PegIFN)-free direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection, a sustained virological response (SVR) rate >95% can be attained with a satisfactory tolerability and shorter treatment duration. However, it remains controversial whether there is any difference in prognosis depending on regimens—PegIFN or DAAs. We compared the probabilities of hepatocellular carcinoma (HCC) development between patients achieving an SVR by PegIFN/ribavirin (PegIFN group, n = 603) and DAAs (DAAs group, n = 479). The DAAs group was significantly older and had a higher proportion of cirrhosis than the PegIFN group. Before adjustment, the DAAs group had a higher HCC incidence than the PegIFN group (p < 0.001). However, by multivariate analyses, the DAAs (vs. PegIFN) group was not associated with HCC risk (adjusted hazard ratio 0.968, 95% confidence interval 0.380–2.468; p = 0.946). Old age, male, higher body mass index, cirrhosis, and lower platelet count were associated with increased HCC risk (all p < 0.05). After propensity score matching (PSM), a similar HCC risk between the two groups was observed (p = 0.372). We also compared HCC incidences according to sofosbuvir (SOF)-based and SOF-free DAAs, showing a similar risk in both groups before adjustment (p = 0.478) and after PSM (p = 0.855). In conclusion, post-SVR HCC risks were comparable according to treatment regimens; PegIFN- vs. DAA-based regimens and SOF-based vs. SOF-free DAA regimens. Further studies with a longer follow-up period are required.

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