Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1743
Peer-review started: April 15, 2021
First decision: June 15, 2021
Revised: June 30, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 27, 2021
Processing time: 223 Days and 6.9 Hours
Insufficient and contradictory data are available about the relation between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) development in patients with hepatitis C virus (HCV).
To analyze differences in basic clinical, radiological, and laboratory characteristics in addition to tumor behavior upon HCC diagnosis between patients with and without a previous history of DAAs exposure.
This multicenter case-control study included 497 patients with chronic HCV-related HCC, allocated into one of two groups according to their history of antiviral treatment for their HCV.
Group I included 151 HCC patients with a history of DAAs, while 346 patients who had never been treated with DAAs were assigned to group II. A significant difference was observed between both groups regarding basic assessment scores (Child, MELD, and BCLC), which tended to have more advanced liver disease and HCC stage upon diagnosis in group I. However, serum albumin was significantly affected, and serum α-fetoprotein was significantly higher in group II (P < 0.001). In addition, group I showed significant HCC multicentricity than group II, while the incidence of portal vein thrombosis was significantly higher in group I (P < 0.001).
The basic clinical scores and laboratory characteristics of HCC patients are advanced in patients who are naïve to DAAs treatment; however, HCC behavior is more aggressive in DAA-treated patients.
Core Tip: Despite the introduction of newer direct-acting antivirals (DAAs), hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) will continue to be a significant public health concern in the coming decades. Post-treatment HCV-related HCC has been discovered to be an emerging issue due to unmet needs for early HCC identification and intervention. In addition, we found that aggressive tumors were more common in DAAs exposed patients, which needs to be investigated further in prospective studies with larger cohorts and necessitates proactive screening for HCC in HCV-treated patients via public or private pharmacovigilance programs.