Risk of Hepatocellular Cancer Recurrence in Hepatitis C Virus+ Patients Treated with Direct-Acting Antiviral Agents

• Published in: Digestive diseases and sciences Vol. 64; no. 11; pp. 3328 - 3336
• Main Authors: Zou, Winnie Y., Choi, Kati, Kramer, Jennifer R., Yu, Xian, Cao, Yumei, El-Serag, Hashem B., Kanwal, Fasiha
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2019; Springer; Springer Nature B.V
• Subjects: Aged; Antiviral Agents - administration & dosage; Antiviral drugs; Biochemistry; Cancer; Cancer therapies; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - epidemiology; Care and treatment; Cohort Studies; Data warehouses; Diseases; Drug Therapy, Combination; Female; Follow-Up Studies; Gastroenterology; Health aspects; Hepatitis; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Hepatology; Humans; Interferon; Liver cancer; Liver Neoplasms - diagnosis; Liver Neoplasms - drug therapy; Liver Neoplasms - epidemiology; Male; Medical records; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - epidemiology; Oncology; Original Article; Protease inhibitors; Relapse; Risk Factors; Studies; Systematic review; Transplant Surgery; Transplants & implants; Treatment Outcome; Veterans; Hepatocellular carcinoma recurrence; Hepatocellular carcinoma; Direct-acting antiviral agents; Hepatitis C virus
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05641-3

Background With advent of direct-acting antiviral agents (DAA), hepatitis C virus (HCV) treatment is dramatically increasing. Although few studies reported rates of hepatocellular carcinoma (HCC) recurrence following DAA treatment, there have been no studies that followed sufficient number of DAA-treated patients after successful HCC treatment to examine HCC recurrence. Methods We conducted a cohort study of HCV+ patients who had successfully treated HCC before initiating DAAs. We conducted medical record reviews to confirm HCC diagnosis, treatment, and remission prior to DAA initiation, and subsequent HCC recurrence. We calculated HCC recurrence rate and examined the recurrent tumor characteristics. We used Cox proportional hazard model to identify factors associated with HCC recurrence. Results We identified 264 HCV+ patients who received DAAs after an average of 30.9 (20.6) months following HCC treatment. HCC recurred in 26.1% patients during 23.3 (9.8) months follow-up, at a rate of 0.38 [0.30, 0.48] per 1000 person-month. Most (82.3%) recurrent HCC were early stage. Receiving non-curative treatment for HCC was associated with a higher risk of recurrence than curative treatment (HR adj  = 2.06, [1.24, 3.40]). The risk of HCC recurrence decreased with longer duration between HCC treatment completion and DAA initiation (HR adj  = 0.97, [0.95, 0.99] per additional month). Compared with patients who achieved sustained virological response (SVR), those without SVR had significantly increased risk of HCC recurrence (HR adj  = 4.17, [1.48, 11.75]). Conclusions We conclude that most HCV+ patients with HCC benefit from DAA treatment; however, timing of DAA initiation after HCC treatment should be carefully considered.