Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2022; 14(6): 1190-1199
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1190
Direct-acting antivirals for hepatitis C virus-infected patients with hepatocellular carcinoma
Kazuto Tajiri, Hiroyuki Ito, Kengo Kawai, Yoshiro Kashii, Yuka Hayashi, Aiko Murayama, Masami Minemura, Terumi Takahara, Yukihiro Shimizu, Ichiro Yasuda
Kazuto Tajiri, Yuka Hayashi, Aiko Murayama, Masami Minemura, Terumi Takahara, Ichiro Yasuda, Department of Gastroenterology, Toyama University Hospital, Toyama 930-0194, Japan
Hiroyuki Ito, Department of Gastroenterology, Takaoka Municipal Hospital, Takaoka 933-8550, Japan
Kengo Kawai, Yukihiro Shimizu, Gastroenterology Center, Nanto Municipal Hospital, Nanto 932-0211, Japan
Yoshiro Kashii, Department of Gastroenterology, Saiseikai Toyama Hospital, Toyama 931-8533, Japan
Author contributions: Tajiri K designed and performed the research and wrote the paper; Ito H, Kawai K, Murayama A, Hayashi Y, Minemura M, Takahara T, and Shimizu Y contributed to the management of patients; Shimizu Y and Yasuda I supervised the work.
Institutional review board statement: This study was reviewed and approved by the ETHICs Committee of Toyama University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient had agreed to treatment with confirmed written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kazuto Tajiri, MD, PhD, Associate Professor, Department of Gastroenterology, Toyama University Hospital, 2630 Sugitani, Toyama 930-0194, Japan. tajikazu@med.u-toyama.ac.jp
Received: January 12, 2022
Peer-review started: January 12, 2022
First decision: March 16, 2022
Revised: March 18, 2022
Accepted: May 28, 2022
Article in press: May 28, 2022
Published online: June 27, 2022
Processing time: 162 Days and 7.2 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients has a high risk of recurrence. Although eradication of HCV is expected to reduce this risk, the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals (DAAs).

AIM

To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC.

METHODS

The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals. The frequency and predictors of HCC recurrence/ occurrence after DAA treatment were included in these analyses. The clinical course of HCC before and after DAA treatment was also evaluated.

RESULTS

HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC. Median recurrence-free survival (RFS) was 1092 d in patients with a history of HCC, and post-DAA HCC recurrence/occurrence was observed in 29 patients (53.7%) with and 5 (1.9%) without a history of HCC over 6 years (P < 0.001). RFS in patients with a history of HCC did not differ significantly before and after DAA treatment. The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment. Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment. Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy.

CONCLUSION

DAA therapy in patients infected with HCV is also effective in patients with a history of HCC. Curative treatment for HCC is desirable before DAA therapy. The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy. Careful observation after DAA therapy is required in patients with a history of HCC.

Keywords: Direct-acting antivirals; Hepatitis C virus; Hepatocellular carcinoma; Recurrence; Liver fibrosis; Curative treatment

Core Tip: To estimate the therapeutic value of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected patients with a history of hepatocellular carcinoma (HCC), the clinical course of HCV patients with or without a history of HCC after DAA therapy was retrospectively analyzed. DAA treatment did not increase the incidence rate of HCC recurrence/occurrence or enhance malignant transformation of HCC in patients with a history of HCC. The risk of HCC recurrence after DAA therapy was significantly associated with the frequency of HCC recurrence/occurrence before DAA therapy.