Highlights
- •There was no significant difference in the early HCC recurrence rate and pattern between IFN-based and DAA therapy.
- •High AFP-L3, short recurrence-free period, and history of multiple HCC treatments were risk factors for early recurrence.
- •Eradication of HCV after curative HCC treatments could preserve liver function, regardless of antiviral therapy regimen.
Background & Aims
It remains controversial whether direct-acting antivirals (DAAs) accelerate the recurrence
of hepatitis C-related hepatocellular carcinoma (HCC) after curative therapy. This
study aimed to evaluate HCC recurrence after DAA treatment of chronic hepatitis C.
Methods
We enrolled patients with a history of successful radiofrequency ablation treatment
for hepatitis C-related HCC who received antiviral therapy with DAAs (DAA group: 147
patients) or with interferon (IFN)-based therapy (IFN group: 156 patients). We assessed
HCC recurrence rates from the initiation of antiviral therapy using the Kaplan-Meier
method and evaluated risk factors for HCC recurrence by multivariate Cox proportional
hazard regression analysis. The recurrence pattern was categorized as follows: intrahepatic
recurrence with a single tumor <2 cm (stage 0), a single tumor or up to 3 tumors ≤3 cm
(stage A), multinodular (stage B), and extrahepatic metastasis or macrovascular invasion
(stage C).
Results
The recurrence rates at 1 and 2 years were 39% and 61% in the IFN group and 39% and
60% in the DAA group, respectively (p = 0.43). Multivariate analysis identified higher lens culinaris agglutinin-reactive fraction of alpha-fetoprotein level, a history of multiple HCC
treatments, and a shorter interval between HCC treatment and initiation of antiviral
therapy as independent risk factors for HCC recurrence. HCC recurrence in stage 0,
A, B, and C was found in 56 (41%), 60 (44%), 19 (14%), and 1 (0.7%) patients in the
IFN group and 35 (44%), 32 (40%), 11 (14%), and 2 (2.5%) patients in the DAA group,
respectively (p = 0.70).
Conclusions
HCC recurrence rates and patterns after initiation of antiviral therapy did not differ
between patients who received IFN-based therapy and DAA therapy.
Lay summary
We detected no significant difference in early hepatocellular carcinoma (HCC) recurrence
rates and patterns between patients who received interferon-based and direct-acting
antiviral therapy after HCC treatment. High lens culinaris agglutinin-reactive fraction of alpha-fetoprotein level, short recurrence-free period,
and a history of multiple HCC treatments were independent risk factors for early HCC
recurrence after the initiation of antiviral therapy.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 15, 2018
Accepted:
September 27,
2018
Received in revised form:
September 10,
2018
Received:
March 6,
2018
Identification
Copyright
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
