Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C
Résumé
BACKGROUND AND AIMS: Arrival of direct-acting antiviral (DAA) agents against hepatitis C virus (HCV) with high-sustained virological response (SVR) rates and very few side effects has drastically changed the management of HCV infection. The impact of DAA exposure on hepatocellular carcinoma (HCC) recurrence after a first remission in patients with advanced fibrosis remains to be clarified. METHODS: 68 consecutive HCV patients with a first HCC diagnosis and under remission, subsequently treated or not with a DAA combination, were included. Clinical, biological, and virological data were collected at first HCC diagnosis, at remission and during the surveillance period. RESULTS: All patients were cirrhotic. Median age was 62 years and 76% of patients were male. Twenty-three patients (34%) were treated with DAAs and 96% of them achieved SVR. Median time between HCC remission and DAA initiation was 7.2 months (IQR: 3.6 - 13.5; range: 0.3 - 71.4) and median time between DAA start and HCC recurrence was 13.0 months (IQR: 9.2 - 19.6; range: 3.0 - 24.7). Recurrence rate was 1.7/100 person-months among treated patients vs 4.2/100 person-months among untreated patients (p=0.008). In multivariate survival analysis, the hazard ratio for HCC recurrence after DAA exposure was 0.24 (95% confidence interval: 0.10-0.55; p\textless0.001). CONCLUSIONS: HCC recurrence rate was significantly lower among patients treated with DAA compared with untreated patients. Given the potential impact of our observation, large-scale prospective cohort studies are needed to confirm these results. This article is protected by copyright. All rights reserved