Risk of Hepatocellular Cancer in HCV Patients Treated With Direct-Acting Antiviral Agents.

By F. Kanwal, J. Kramer, S. Asch, M. Chayanupatkul, Yumei Cao, H. B. EL‐SERAG. Gastroenterology, 2017

823 citations recorded by the source corpus.

BACKGROUND AND AIMS The risk of hepatocellular cancer (HCC) after sustained virological response (SVR) with direct-acting antivirals (DAA) is unclear. Our aim was to examine the risk and determinants of HCC in patients cured with DAA. METHODS We conducted a retrospective cohort study of hepatitis C virus patients who were treated with DAA in any of the 129 Veterans Health Administration hospitals between January 1, 2015 and December 31, 2015. We calculated the annual incidence rates of HCC by SVR. We used Cox regression models to compare the risk of HCC in patients with vs those without SVR and to identify factors associated with incident HCC among patients with SVR. We reviewed a sample of HCC patients for tumor size and stage at diagnosis. RESULTS Among 22,500 patients treated with DAA (19,518 with SVR; 2982 without SVR), the mean (standard deviation) age was 61.6 (6.1) years, and 39.0% had cirrhosis. There were 271 new cases of HCC, including 183 in patients with SVR. Compared with patients without SVR, those with SVR had a significantly reduced risk of HCC (0.90 vs 3.45 HCC/100 person-years; adjusted hazard ratio, 0.28, 95% CI=0.22-0.36). Patients with cirrhosis had the highest annual incidence of HCC after SVR (1.82 vs 0.34/100 person-years in patients without cirrhosis; adjusted hazard ratio, 4.73. 95% CI, 3.34-6.68). Most (>44.8%) HCC were classified as stage I. Maximum size of the largest lesion was ≤5 cm in over 75% of cases. CONCLUSIONS Among patients treated with DAA, SVR was associated with a considerable reduction in the risk of HCC. We did not find any evidence to suggest that DAAs promote HCC. However, in patients with SVR, the absolute risk of HCC remained high in patients with established cirrhosis. These patients should be considered for ongoing HCC surveillance.

Subfields: Animal Science and Zoology, Hepatology

View Paper: https://www.semanticscholar.org/paper/6e237efa72dcaca50da1642909f3cb5656d5adc3

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Citations in the corpus

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. (2018, methodology): “were treated with DAA examining in the VA population demonstrated a reduction in the incidence of hepatocellular carcinoma in patients achieving a SVR.(78) To adequately assess the risk of HCC recurrence/development, it is essential to determine if treated patients were properly screened for HCC bef”
Liver Fibrosis: Mechanistic Concepts and Therapeutic Perspectives (2020, background): “While cure of HCV infection has been shown to reduce liver disease complications and HCC risk, a significant risk to develop HCC persists in advanced fibrosis [183,184].”
Changes in the Global Burden of Chronic Liver Diseases From 2012 to 2017: The Growing Impact of NAFLD (2020, background): “(42-44) Therefore, it is possible that highly effective direct-acting antiviral medications for HCV infection could eventually decrease the number of cases with LC, thus lowering the burden of HCV in mortality and DALYs.(45-47) ALD is the most common etiology of cirrhosis in Latin America and Centra”
AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma (2023, neutral): “[37] HBV vaccination has also been shown to significantly reduce HCC risk, so this should be performed in all newborns as well as high-risk adults who failed to undergo vaccination at birth.”