Antiviral Therapy Utilization and 10-Year Outcomes in Resected Hepatitis B Virus- and Hepatitis C Virus-Related Hepatocellular Carcinoma

• Published in: Journal of clinical oncology Vol. 42; no. 7; pp. 790 - 799
• Main Authors: Huang, Daniel Q., Hoang, Joseph K., Kamal, Rubayet, Tsai, Pei-Chien, Toyoda, Hidenori, Yeh, Ming-Lun, Yasuda, Satoshi, Leong, Jennifer, Maeda, Mayumi, Huang, Chung-Feng, Won Jun, Dae, Ishigami, Masatoshi, Tanaka, Yasuhito, Uojima, Haruki, Ogawa, Eiichi, Abe, Hiroshi, Hsu, Yao-Chun, Tseng, Cheng-Hao, Alsudaney, Manaf, Yang, Ju Dong, Yoshimaru, Yoko, Suzuki, Takanori, Liu, Joanne K., Landis, Charles, Dai, Chia-Yen, Huang, Jee-Fu, Chuang, Wan-Long, Schwartz, Myron, Dan, Yock Young, Esquivel, Carlos, Bonham, Andrew, Yu, Ming-Lung, Nguyen, Mindie H.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.03.2024
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.23.00757

PURPOSEThere are limited data on antiviral treatment utilization and its impact on long-term outcomes of hepatitis B virus (HBV)- and hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after hepatic resection. We aimed to determine the utilization and impact of antivirals in HBV- and HCV-related HCC.METHODSThis cohort study included 1,906 participants (1,054 HBV-related HCC and 852 HCV-related HCC) from 12 international sites. All participants had HBV- or HCV-related HCC and underwent curative surgical resection. The primary outcome was the utilization of antiviral therapy, and the secondary outcome was long-term overall survival (OS).RESULTSThe mean (±standard deviation [SD]) age was 62.1 (±11.3) years, 74% were male, and 84% were Asian. A total of 47% of the total cohort received antiviral therapy during a mean (±SD) follow-up of 5.0 (±4.3) years. The overall antiviral utilization for participants with HBV-related HCC was 57% and declined over time, from 65% before 2010, to 60% from 2010 to 2015, to 47% beyond 2015, P < .0001. The overall utilization of antivirals for HCV-related HCC was 35% and increased over time, from 24% before 2015 to 74% from 2015 and beyond, P < .0001. The 10-year OS was lower in untreated participants for both HBV (58% v 61%) and HCV participants (38% v 82%; both P < .0001). On multivariable Cox regression analysis adjusted for relevant confounders, antiviral therapy initiated before or within 6 months of HCC diagnosis was independently associated with lower mortality in both HBV- (adjusted hazard ratio [aHR], 0.60 [95% CI, 0.43 to 0.83]; P = .002) and HCV-related HCC (aHR, 0.18 [95% CI, 0.11 to 0.31]; P < .0001).CONCLUSIONAntiviral therapy is associated with long-term survival in people with HBV- or HCV-related HCC who undergo curative resection but is severely underutilized.