HCV cirrhosis: DAAs boost survival after successful HCC treatment

  • Cabibbo G & al.
  • J Hepatol
  • 5 Apr 2019

  • International Clinical Digest
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Takeaway

  • Direct-acting antiviral (DAA) treatment significantly improves survival in patients with HCV cirrhosis who have undergone curative treatment for early hepatocellular carcinoma (HCC).

Why this matters

  • The survival benefit appears to be driven by reduced risk for hepatic decompensation.

Study design

  • Prospective RESIST-HCV data for 163 patients with HCV cirrhosis (Child-Pugh class A, 84%) treated with DAAs after achieving complete radiologic response with resection/ablation for early-stage HCC.
  • Control group consisted of 328 DAA-untreated patients from the ITA.LI.CA cohort.
  • Analysis included 102 propensity-matched pairs (mean age, ~71 years).
  • Funding: RESIST-HCV funded by Gilead, MSD, Abbvie, and BMS.

Key results

  • Outcomes at median 21.4-month follow-up in the DAA vs no-DAA groups:
    • Deaths: 6.9% vs 17.7% (HR=0.39; P=.03).
    • Hepatic decompensation: 5.9% vs 13.7% (HR=0.32; P=.02).
  • No difference between groups in terms of HCC recurrence: 27.5% vs 37.3% (P=.15).
  • Among DAA-treated patients, sustained virologic response (SVR) was the only variable associated with reduced mortality in multivariate analysis (HR=0.02; P<.001>
  • SVR was independently associated with reduced HCC recurrence (HR=0.25; P<.001 and hepatic decompensation p=".02).</li">

Limitations

  • Observational design with historical control.
  • HCV genotypes, DAA regimens, SVR rates not specified.

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