Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C‐infected Egyptian cohort: A comparative analysis

Abstract

In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

Predictors of hepatocellular carcinoma after hepatitis C virus eradication following direct-acting antiviral treatment: relationship with serum zinc

“…Moreover, we excluded patients with a history of HCC and those who reported a high rate of HCC recurrence in advance. (7,(40)(41)(42)(43)(44) In the present study, a multivariate analysis showed lower serum zinc levels and higher AFP levels at baseline. As several laboratory parameters changed in patients who achieved SVR following DAA, including reductions in AFP and M2BPGi levels, increases in platelet count, albumin, and serum zinc levels, (28,29,(45)(46)(47) we carried out the multivariate analysis at both baseline and EOT.…”

Hepatitis C Virus - Related Hepatocellular Carcinoma in the Era of Direct - Acting Antiviral Agents

“…The data showed an unexpectedly high rate and pattern of tumor recurrence coinciding with HCV clearance. Other studies (52,53), with similar results, held the shared view that patients receiving DAAs had a greater risk for the recurrence of HCC. Conti et al, also found that after DAA therapy, 17 of 59 (28.8%) patients had HCC recurrence, whereas only nine of 285 (3.16%) patients were diagnosed with HCC for the first time (47).…”

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

“…Study characteristics were summarised in Tables and . Fifty‐six studies were included, with a total of 5522 patients with HCC, while 27 studies enrolled non‐HCC patients as control groups. Fifty‐three (95%) studies were observational cohorts (45 retrospective and eight prospective) and three studies were clinical trials.…”