Surgical outcomes for hepatocellular carcinoma detected after hepatitis C virus eradiation by direct‐acting antivirals

Tanaka, Shogo; Shinkawa, Hiroji; Tamori, Akihiro; Takemura, Shigekazu; Takahashi, Shinji; Amano, Ryosuke; Kimura, Kenjiro; Ohira, Go; Kawada, Norifumi; Kubo, Shoji

doi:10.1002/jso.26184

Cited by 9 publications

(10 citation statements)

References 37 publications

(89 reference statements)

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“…Results of a previous study of propensity score-matched cohorts indicated that the rate of disease-free survival was better in patients with HCC detected after DAA-induced SVR than in those without SVR or HCV treatment. 11 In this study, the disease-free survival rate after liver resection was better in the DAA-HCC group than in the control group according to univariable analysis but not according to multivariable analysis. Exclusion of patients with HCC recurrence within 1 year after liver resection might have weakened the difference between the two groups.…”

Section: Discussionmentioning

confidence: 52%

“…9,10 Results of a previous study indicated that in patients in whom HCC was detected after DAA-induced SVR, this treatment suppressed postoperative recurrence, in comparison with patients who did not receive antiviral drugs or those without DAA-or IBTinduced SVR. 11 However, the effect of DAA-induced SVR after treatment, including liver resection, has been controversial; some recent studies have shown unexpected high recurrence rates after DAA therapy, 12,13 whereas other studies have demonstrated contradictory findings. [14][15][16][17][18][19][20][21] Several problems such as the timing of DAA therapy and heterogenous characteristics of patients were indicated as the causes of discrepancies, but of much more importance is whether postoperative recurrence and prognosis after liver resection in patients with postoperative DAA-induced SVR are similar to those in patients in whom HCC was detected after DAA-induced SVR and better than those in patients without DAA-induced SVR.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative direct‐acting antiviral treatment after liver resection in patients with hepatitis C virus‐related hepatocellular carcinoma

Tanaka¹,

Shinkawa²,

Tamori

et al. 2021

Hepatology Research

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Aim:We investigated effects of direct-acting antiviral (DAA)-induced sustained virological response (SVR) after liver resection in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) for postoperative recurrence and survival.Methods: Surgical outcomes in 18 patients with postoperative DAA-induced SVR (HCC-DAA group) were compared with those in 23 patients with preoperative DAA-induced SVR (DAA-HCC group) and those in 10 patients who did not receive DAA therapy (control group). Patients who received DAA therapy >1 year after surgery and those with recurrence <1 year after surgery were excluded.Results: Serum concentrations of aminotransferases improved 1 year after surgery in both the HCC-DAA and DAA-HCC groups. The number of HCC-DAA patients with albumin-bilirubin (ALBI) grade 1 increased from 11 to 15. The disease-free survival rate did not differ between HCC-DAA group (3 years, 60%) and the other two groups (DAA-HCC group, 92% and control group, 60%). The 3-year overall survival rates were better in the DAA-HCC group (84%) and HCC-DAA group (100%) than in the control group (46%; all ps < 0.05 according to Holm's test). Multivariable analysis revealed that tumor stage was an independent risk factor for postoperative recurrence, and ALBI grade at 1 year after surgery was predictive of postoperative survival, but DAA-induced SVR was neither.Conclusions: Although postoperative DAA-induced SVR itself may not suppress postoperative recurrence, improvement in liver function as a result of DAA administration after surgery may prolong postoperative survival.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Postoperative direct‐acting antiviral treatment after liver resection in patients with hepatitis C virus‐related hepatocellular carcinoma

Tanaka¹,

Shinkawa²,

Tamori

et al. 2021

Hepatology Research

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“…1,22 By contrast, chronic hepatitis C is much more common in Japan, and sustained viral responses might not be high in the study patients considering the recent introduction of direct acting antiviral agents. 23,24 The findings of this study suggest that inferior outcomes in Japanese patients may be associated with older age, poorer liver function, more frequent hepatitis C virus infection, and more aggressive tumor biology.…”

Section: Discussionmentioning

confidence: 83%

Validation of quantitative prognostic prediction using ADV score for resection of hepatocellular carcinoma: A Korea–Japan collaborative study with 9200 patients

Kang

Hwang

Kaibori

et al. 2023

J Hepato Biliary Pancreat

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BackgroundA score derived from the concentrations of α‐fetoprotein (AFP) and des‐γ‐carboxy prothrombin (DCP) and tumor volume (TV), called ADV score, has been shown to be prognostic of hepatocellular carcinoma (HCC) recurrence following hepatic resection (HR) or liver transplantation.MethodsThis multicenter, multinational validation study included 9200 patients who underwent HR from 2010 to 2017 at 10 Korean and 73 Japanese centers, and were followed up until 2020.ResultsAFP, DCP, and TV showed weak correlations (ρ ≤ .463, r ≤ .189, p < .001). Disease‐free survival (DFS), overall survival (OS), and post‐recurrence survival rates were dependent on 1.0 log and 2.0 log intervals of ADV scores (p < .001). Receiver operating characteristic (ROC) curve analysis showed that ADV score cutoffs of 5.0 log for DFS and OS yielded the areas under the curve ≥ .577, with both being significantly prognostic of tumor recurrence and patient mortality at 3 years. ADV score cutoffs of ADV 4.0 log and 8.0 log, derived through K‐adaptive partitioning method, showed higher prognostic contrasts in DFS and OS. ROC curve analysis showed that an ADV score cutoff of 4.2 log was suggestive of microvascular invasion, with both microvascular invasion and an ADV score cutoff of 4.2 log showing similar DFS rates.ConclusionsThis international validation study demonstrated that ADV score is an integrated surrogate biomarker for post‐resection prognosis of HCC. Prognostic prediction using ADV score can provide reliable information that can assist in planning treatment of patients with different stages of HCC and guide individualized post‐resection follow‐up based on the relative risk of HCC recurrence.

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“…Our study analyzed the real‐world survival advantages of antiviral agents (DAAs or IFN) in patients with HCV who underwent liver resection for primary HCC. A number of recent studies evaluated the survival advantages and recurrence rate following HCV therapy in individuals with surgically treated HCC 9,50–53 . Osaka group reported long‐term outcomes of patients with surgically treated HCC following HCV therapy (mostly IFN 50,51 and a small patient number of DAAs 52 ).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C treatment and long‐term outcome of patients with hepatocellular carcinoma after resection

Cheng

Hsiao

et al. 2023

J of Gastro and Hepatol

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Background and AimThis study aimed to investigate the survival outcomes of antiviral agents (direct‐acting antivirals [DAAs] or interferon [IFN]) in patients with hepatitis C virus who underwent liver resection for primary hepatocellular carcinoma.MethodsThis retrospective single‐center study included 247 patients, between 2013 and 2020, being treated with DAAs (n = 93), IFN (n = 73), or no treatment (n = 81). Overall survival (OS), recurrence‐free survival (RFS), and risk factors were analyzed.ResultsAfter a median follow‐up time of 50.4 months, the rates of 5‐year OS and RFS in the IFN, DAA, and no treatment groups were 91.5% and 55.4%, 87.2% and 39.8%, and 60.9% and 26.7%, respectively. One hundred and twenty‐eight (51.6%) patients developed recurrence; recurrence was mostly (86.7%) intrahepatic, and 58 (23.4%) developed early recurrence, most of which received no antiviral treatment. The OS and RFS were similar between patients who received antiviral treatment before (50.0%) and after surgery, but longer survival was observed in patients achieving sustained virologic response. In multivariate analysis, antiviral treatment was protective for OS (hazard ratio [HR] 0.475, 95% confidence interval [CI]: 0.242–0.933) with significance but not RFS, in contrast to microvascular invasion (OS HR 3.389, 95% CI: 1.637–7.017; RFS HR 2.594, 95% CI: 1.520–4.008). In competing risk analysis, DAAs (subdistribution HR 0.086, 95% CI: 0.007–0.991) were protective against hepatic decompensation events but not recurrence events.ConclusionIn patients with hepatitis C virus, antiviral treatment suggested OS benefit for primary hepatocellular carcinoma after resection, and DAAs might be protective against hepatic decompensation. Following adjustment for oncological factors, IFN and DAA treatment was not significantly advantageous relative to the other.

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Surgical outcomes for hepatocellular carcinoma detected after hepatitis C virus eradiation by direct‐acting antivirals

Cited by 9 publications

References 37 publications

Postoperative direct‐acting antiviral treatment after liver resection in patients with hepatitis C virus‐related hepatocellular carcinoma

Postoperative direct‐acting antiviral treatment after liver resection in patients with hepatitis C virus‐related hepatocellular carcinoma

Validation of quantitative prognostic prediction using ADV score for resection of hepatocellular carcinoma: A Korea–Japan collaborative study with 9200 patients

Hepatitis C treatment and long‐term outcome of patients with hepatocellular carcinoma after resection

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