The association between hepatocellular carcinoma and direct‐acting anti‐viral treatment in patients with decompensated cirrhosis

Abstract

Background: Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. Aim: To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. Methods: All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. Results: Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165(87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. Conclusion:There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate. | 205MECCI Et al.

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

“…There are several issues relevant to DAA therapy among patients with HCC. First, initial data suggested a potential increased risk of HCC recurrence, although subsequent studies did not support these findings . Second, in response to the controversy around HCC recurrence risk, the timing of DAA therapy in relation to HCC management became a point of debate .…”

“…First, initial data suggested a potential increased risk of HCC recurrence, [8][9][10][11][12][13][14] although subsequent studies did not support these findings. [15][16][17][18][19][20][21][22] Second, in response to the controversy around HCC recurrence risk, the timing of DAA therapy in relation to HCC management became a point of debate. [23][24][25] For example, some recommended DAA treatment deferral (ie at least 4-6 months) following potentially curative HCC management.…”

Letter: a 5‐year long‐term follow‐up study after DAA treatment confirms a reduced HCC risk in a central European cohort of HCV patients with liver cirrhosis

“…However, a current paper published in this journal found no difference between tumour size, progression or survival between viraemic and non-viraemic patients. 5 Few long-term follow-up data for more than 3 years after direct acting antiviral (DAA) treatment of HCV cirrhosis are available. We previously reported a cohort of 373 prospectively monitored patients with chronic hepatitis C receiving IFN-free therapies against HCV since January 2014.…”

Letter: hepatocellular carcinoma negatively affects sustained virological response of direct‐acting anti‐viral treatment in decompensated cirrhosis

“…We read with great interest the paper by Chang et al 1 Their study suggested that maternal tenofovir therapy decreased maternal hepatitis B virus (HBV) level and neonatal viremia and that positive neonatal HBV DNA was highly correlated with chronic HBV infection in children. However, we still have some concerns about the study.…”

“…response (SVR) rate than patients without HCC (68% vs 87%, P < .001, odds ratio: 3.13, 95%CI: 1.64-5.99). 1 We have several comments on the latter.…”