Direct‐Acting Antivirals Reduce the Risk of Tumor Progression of Hepatocellular Carcinoma after Curative Treatment

Hepatocellular carcinoma (HCC) has high recurrence rates. HCC sometimes progresses from early-stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage 0/A) to advanced-stage HCC after repeated recurrences and treatments. HCC progression deteriorates quality of life and prognosis. However, the effect of direct-acting antiviral (DAA)-induced sustained virologic response (SVR) on HCC progression remains uninvestigated.We conducted a retrospective cohort study of patients with hepatitis C virus-related HCC with BCLC stage 0/A diagnosed for the first time and treated by curative resection or ablation. Using a time-varying method, we estimated the risk of tumor progression (defined as progression to BCLC stage B-D) and liver-related death and the characteristics of repeated recurrence. Overall, 165 patients were enrolled. Following curative HCC treatment, 72 patients received DAA therapy (DAA-treated group), whereas 93 did not (untreated group). Approximately 75% of the recurrences were at an early stage and expected to be disease-free by retreatment. We recorded 56 tumor progressions, of which 60.7% were observed after second recurrence. Multivariate adjusted time-varying Cox regression analysis showed that the DAA-induced SVR significantly reduced the risk of tumor progression (hazard ratio [HR] 0.28; p=0.001) and liver-related death (HR 0.12; p<0.001). The annual incidence of HCC treatment until tumor progression was 82.8% and 23.9% in the untreated and DAA-treated groups, respectively (HR 0.30; p<0.001). DAA-induced SVR significantly reduced the risk for tumor progression and liver-related death and the frequency of HCC treatment following curative treatment for HCC at BCLC stage 0/A.

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