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| Hepatocellular carcinoma incidence post direct-acting antivirals in hepatitis C-related advanced fibrosis/cirrhosis patients in Australia |
| Patrick P Y Chan a , b , Miriam T Levy a , b , Nicholas Shackel a , b , Scott A Davison a , b , Emilia Prakoso a , c , ∗ |
a Department of Gastroenterology and Hepatology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia
b South Western Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
c Central Clinical School - The Faculty of Medicine and Health, University of Sydney, NSW 2050, Australia
∗ Corresponding author.
E-mail address: Emilia.Prakoso@health.nsw.gov.au (E. Prakoso). |
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Abstract 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.
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2020, Vol. 19 
