Gut Liver.  2021 May;15(3):410-419. 10.5009/gnl20151.

Independent Risk Factors for Hepatocellular Carcinoma Recurrence after Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C

Affiliations
  • 1Departments of Gastroenterology, Ajou Research Institute for Innovative Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 2Departments of Biomedical Informatics, Ajou Research Institute for Innovative Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 3Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
  • 7Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 8Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
  • 9Division of Hepatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 10Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Abstract

Background/Aims
This study was performed to evaluate the efficacy of direct-acting antivirals (DAAs) in Korean patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) and to investigate the risk factors associated with HCC recurrence.
Methods
A total of 100 patients with HCV-related HCC, who were treated with DAAs between May 2015 and December 2016, were recruited from seven university hospitals in Korea. Claim data of 526 patients with HCC obtained from the Health Insurance Review and Assessment Service in South Korea were used for external validation of the results.
Results
Among the 100 patients, 88% achieved a sustained virological response (SVR) 12 weeks after the end of DAA therapy (SVR12), and 37% experienced HCC recurrence after DAA therapy. Short last HCC treatment durability (<12 months) before DAA commencement was independently associated with HCC recurrence (hazard ratio [HR], 2.89; p=0.011). In the nationwide validation cohort, 20.3% of the patients experienced HCC recurrence. The last HCC treatment with a noncurative method, a short last HCC treatment durability (<12 months), and a longer total duration of HCC treatment (≥18 months) were independently related with HCC recurrence (HR3.73, p<0.001; HR 3.34, p<0.001; and HR 1.74, p=0.006; respectively).
Conclusions
DAA therapy showed an acceptable SVR12 rate in patients with HCV-related HCC. Short last HCC treatment durability (<12 months) was associated with HCC recurrence after DAA therapy. This finding suggests that the last HCC treatment durability is an important predictor of HCC recurrence after DAA therapy.

Keyword

Carcinoma; hepatocellular; Antiviral agents; Risk factors; Hepatitis C; chronic; Recurrence
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