Background:Despite efficacy in HCV eradication,direct-acting antiviral(DAA)therapy has raised controversies around their impact on hepatocellular carcinoma(HCC)incidence.Herein we reported the first Australian data on...Background:Despite efficacy in HCV eradication,direct-acting antiviral(DAA)therapy has raised controversies around their impact on hepatocellular carcinoma(HCC)incidence.Herein we reported the first Australian data on HCC incidence in DAA-treated HCV patients with advanced fibrosis/cirrhosis.Methods:We conducted a retrospective single center study of DAA-treated HCV patients with advanced fibrosis/cirrhosis from April 2015 to December 2017.Patients with prior HCC were included if they had complete response to HCC treatment.Results:Among 138 patients who completed DAA therapy,133(96.4%)achieved sustained virologic response(median follow-up 23.8 months).Ten had prior HCC and 5/10(50.0%)developed recurrence,while de novo HCC developed in 7/128(5.5%).Median time from DAA to HCC diagnosis was 34 weeks in recurrent HCC vs.de novo 52 weeks(P=0.159).In patients with prior HCC,those with recurrence(vs.without)had shorter median time between last HCC treatment and DAA(12 vs.164 weeks,P<0.001).On bivariate analysis,failed sustained virologic response at 12 weeks(SVR12)(P=0.011),platelets(P=0.005),model for end-stage liver disease(MELD)score(P=0.029),alpha fetoprotein(AFP)(P=0.013),and prior HCC(P<0.001)were associated with HCC post-DAA.On multivariate analysis,significant factors were prior HCC(OR=4.80;95%CI:1.47–48.50;P=0.010),failed SVR12(OR=2.83;95%CI:1.71–16.30;P=0.016)and platelets(OR=0.97;95%CI:0.95–0.99;P=0.009).Conclusions:Our study demonstrates a high incidence of recurrent HCC in HCV patients with advanced fibrosis/cirrhosis treated with DAA.Factors associated with HCC development post-DAA were more advanced liver disease,failed SVR12 and prior HCC,with higher rates of recurrence in those who started DAA earlier.展开更多
文摘Background:Despite efficacy in HCV eradication,direct-acting antiviral(DAA)therapy has raised controversies around their impact on hepatocellular carcinoma(HCC)incidence.Herein we reported the first Australian data on HCC incidence in DAA-treated HCV patients with advanced fibrosis/cirrhosis.Methods:We conducted a retrospective single center study of DAA-treated HCV patients with advanced fibrosis/cirrhosis from April 2015 to December 2017.Patients with prior HCC were included if they had complete response to HCC treatment.Results:Among 138 patients who completed DAA therapy,133(96.4%)achieved sustained virologic response(median follow-up 23.8 months).Ten had prior HCC and 5/10(50.0%)developed recurrence,while de novo HCC developed in 7/128(5.5%).Median time from DAA to HCC diagnosis was 34 weeks in recurrent HCC vs.de novo 52 weeks(P=0.159).In patients with prior HCC,those with recurrence(vs.without)had shorter median time between last HCC treatment and DAA(12 vs.164 weeks,P<0.001).On bivariate analysis,failed sustained virologic response at 12 weeks(SVR12)(P=0.011),platelets(P=0.005),model for end-stage liver disease(MELD)score(P=0.029),alpha fetoprotein(AFP)(P=0.013),and prior HCC(P<0.001)were associated with HCC post-DAA.On multivariate analysis,significant factors were prior HCC(OR=4.80;95%CI:1.47–48.50;P=0.010),failed SVR12(OR=2.83;95%CI:1.71–16.30;P=0.016)and platelets(OR=0.97;95%CI:0.95–0.99;P=0.009).Conclusions:Our study demonstrates a high incidence of recurrent HCC in HCV patients with advanced fibrosis/cirrhosis treated with DAA.Factors associated with HCC development post-DAA were more advanced liver disease,failed SVR12 and prior HCC,with higher rates of recurrence in those who started DAA earlier.
