Improved prognosis of hepatitis C‐related hepatocellular carcinoma in the era of direct‐acting antivirals

• Published in: Hepatology communications Vol. 6; no. 9; pp. 2496 - 2512
• Main Authors: Fukumoto, Tsuyoshi, Minami, Tatsuya, Moriyama, Makoto, Yamada, Tomoharu, Wake, Taijiro, Kinoshita, Mizuki Nishibatake, Fujiwara, Naoto, Nakagomi, Ryo, Nakatsuka, Takuma, Sato, Masaya, Enooku, Kenichiro, Nakagawa, Hayato, Fujishiro, Mitsuhiro, Shiina, Shuichiro, Koike, Kazuhiko, Tateishi, Ryosuke
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.09.2022; John Wiley and Sons Inc; Wolters Kluwer Health/LWW
• Subjects: Ascites; Cancer therapies; Gastroenterology; Hepatitis C; Infections; Liver cancer; Magnetic resonance imaging; Medical prognosis; Mortality; Original; Patients; Sensitivity analysis; Trends; Tumors; Ultrasonic imaging; Japan
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1002/hep4.2010

The prognostic impact of direct‐acting antivirals (DAAs) on patients with hepatitis C‐related hepatocellular carcinoma (C‐HCC) is still unclear. This study aimed to evaluate the prognosis of C‐HCC in the DAA era. We enrolled 1237 consecutive patients with treatment‐naive C‐HCC who underwent radical radiofrequency ablation between 1999 and 2019. We also enrolled 350 patients with nonviral HCC as controls. We divided these patients into three groups according to the year of initial treatment: 1999–2005 (cohort 1), 2006–2013 (cohort 2), and 2014–2019 (cohort 3). The use of antiviral agents and their effect in patients with C‐HCC was investigated. Overall survival was evaluated for each cohort using the Kaplan‐Meier method and a multivariable Cox proportional hazards regression model. Sustained virologic response (SVR) was achieved in 52 (10%), 157 (26%), and 102 (74%) patients with C‐HCC in cohorts 1–3, respectively. The 3‐ and 5‐year survival rates of patients with C‐HCC were 82% and 59% in cohort 1; 80% and 64% in cohort 2; and 86% and 78% in cohort 3, respectively (p = 0.003). Multivariable analysis adjusted for age, liver function, and tumor extension showed that the prognosis of C‐HCC improved in cohort 3 compared to cohort 1 (adjusted hazard ratio [aHR], 0.49; 95% confidence interval [CI], 0.32–0.73; p < 0.001), whereas the prognosis of nonviral HCC did not improve significantly (aHR, 0.96; 95% CI, 0.59–1.57; p = 0.88). The prognosis of C‐HCC drastically improved with the advent of DAAs. The prognosis of hepatitis C‐related HCC has significantly improved in the era of direct‐acting antivirals, probably due to the increase in the number of patients with SVR. Whereas the prognosis of HCC with non‐viral etiology has not improved.