Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

Kazuto Tajiri; Hiroyuki Ito; Kengo Kawai; Yoshiro Kashii; Yuka Hayashi; Aiko Murayama; Masami Minemura; Terumi Takahara; Yukihiro Shimizu; Ichiro Yasuda

doi:10.4254/wjh.v14.i6.1190

Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma

World J Hepatol. 2022 Jun 27;14(6):1190-1199. doi: 10.4254/wjh.v14.i6.1190.

Authors

Affiliations

¹ Department of Gastroenterology, Toyama University Hospital, Toyama 930-0194, Japan. tajikazu@med.u-toyama.ac.jp.
² Department of Gastroenterology, Takaoka Municipal Hospital, Takaoka 933-8550, Japan.
³ Gastroenterology Center, Nanto Municipal Hospital, Nanto 932-0211, Japan.
⁴ Department of Gastroenterology, Saiseikai Toyama Hospital, Toyama 931-8533, Japan.
⁵ Department of Gastroenterology, Toyama University Hospital, Toyama 930-0194, Japan.

Abstract

Background: Hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients has a high risk of recurrence. Although eradication of HCV is expected to reduce this risk, the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals (DAAs).

Aim: To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC.

Methods: The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals. The frequency and predictors of HCC recurrence/ occurrence after DAA treatment were included in these analyses. The clinical course of HCC before and after DAA treatment was also evaluated.

Results: HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC. Median recurrence-free survival (RFS) was 1092 d in patients with a history of HCC, and post-DAA HCC recurrence/occurrence was observed in 29 patients (53.7%) with and 5 (1.9%) without a history of HCC over 6 years (P < 0.001). RFS in patients with a history of HCC did not differ significantly before and after DAA treatment. The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment. Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment. Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy.

Conclusion: DAA therapy in patients infected with HCV is also effective in patients with a history of HCC. Curative treatment for HCC is desirable before DAA therapy. The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy. Careful observation after DAA therapy is required in patients with a history of HCC.

Keywords: Curative treatment; Direct-acting antivirals; Hepatitis C virus; Hepatocellular carcinoma; Liver fibrosis; Recurrence.