Efficacy of Hepatitis C Virus Eradication After Curative Treatment for Hepatocellular Carcinoma in Patients With Advanced Hepatocellular Carcinoma and Decreased Hepatic Functional Reserve

A Nationwide, Multicentre Study by the Japanese Red Cross Liver Study Group

Toshie Mashiba; Kouji Joko; Masayuki Kurosaki; Hironori Ochi; Hiroyuki Marusawa; Yasushi Uchida; Hideki Fujii; Yuji Kojima; Hideo Yoshida; Tohru Goto; Takehiro Akahane; Masahiko Kondo; Keiji Tsuji; Akeri Mitsuda; Chitomi Hasebe; Atsunori Kusakabe; Tetsuro Sohda; Koichiro Furuta; Haruhiko Kobashi; Chikara Ogawa; Yasushi Ide; Hirotaka Arai; Kazuhiko Okada; Masaya Shigeno; Riko Nonogi; Namiki Izumi

Disclosures

J Viral Hepat. 2022;29(7):551-558. 

In This Article

Abstract and Introduction

Abstract

Improvements in the hepatocellular carcinoma (HCC) recurrence rate and survival have been frequently reported following virus eradication after hepatitis C virus (HCV)-related HCC cure. However, the efficacy of direct-acting antiviral (DAA) therapy in patients who included those with advanced HCC and decreased hepatic functional reserve is unknown. A comparative examination was retrospectively conducted of 141 patients with hepatitis C who started DAA therapy within 1 year after undergoing curative HCC treatment and showed a sustained viral response (SVR) and 327 patients who underwent curative treatment for HCV-related HCC and did not subsequently receive antiviral therapy. Whether DAA therapy was given was identified as an independent factor related to both HCC recurrence and survival. Both the recurrence and survival rates improved significantly with DAA therapy in Child-Pugh (CP)-A, whereas no difference in the recurrence rate was seen with DAA therapy in CP-B. However, the survival rate was significantly higher in the DAA group in this class. Similarly, dividing the patients by the Milan criteria showed significant improvements in the recurrence rate and survival with DAA therapy in patients within the Milan criteria. Patients with HCC beyond the Milan criteria showed no difference in recurrence rates, but the DAA group tended to have higher survival rates. Thus, DAA after curative therapy for HCC can be expected to improve survival in patients with advanced HCC or decreased hepatic functional reserve. HCV should be aggressively eradicated in all patients eligible for curative treatment of HCC.

Introduction

Direct-acting antiviral (DAA) therapy has been found to provide a strong therapeutic effect (cure rates of >80%–90%) in patients with advanced liver disease, including hepatocellular carcinoma (HCC).[1–5] Moreover, there have been numerous reports of decreased HCC recurrence in patients after HCC cure.[6–9] The authors previously compared interferon (IFN) therapy and DAA therapy with respect to HCC recurrence after antiviral therapy following hepatitis C virus (HCV)-related HCC cure and found no difference between the groups.[10] Furthermore, improved survival rates have been reported with DAA therapy after HCC cure.[8,11,12] However, whether DAA therapy after HCC treatment benefits patients with advanced-stage HCC or HCC with decompensated cirrhosis has not been adequately examined.[13] HCC recurrence and survival rates were compared between patients in the Japanese Red Cross Liver Study Group who underwent DAA therapy after HCC treatment and patients stratified according to HCC stage and hepatic functional reserve who did not undergo HCV treatment.

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