- Most HCV+ patients with hepatocellular carcinoma (HCC) benefit from treatment with direct-acting antivirals (DAAs), but timing should be carefully considered.
Why this matters
- An increased risk for HCC recurrence has been reported post-DAA therapy, but in a small study; subsequent studies reported mixed results.
- Closer surveillance indicated for patients who received noncurative HCC therapy, received DAAs within 2 years of HCC care, or fail to achieve sustained virologic response (SVR).
- Nationwide retrospective Veteran’s Affairs (VA) cohort study of 264 HCV-infected patients who received DAAs an average of 30.9±20.6 months after successful HCC treatment (potentially curative, 28.8%; noncurative, 71.2%).
- Mean age at DAA initiation, 66.6±5.1 years; 49.2% were white and 40.3% were African American.
- Funding: Veteran’s Administration, VA Medical Center in Houston, TX.
- Over a mean of 23.3±9.8 months, 26.1% developed HCC recurrence.
- Incidence rate: 0.38 per 1000 person-months.
- Mean time to recurrence, 12.2±8.0 months.
- 82.3% were early-stage.
- Noncurative HCC treatment was tied to a doubled risk for recurrence (aHR=2.06; P=.005), as was non-SVR (aHR=2.24; P=.02).
- HCC recurrence risk decreased with lengthening interval between HCC treatment and DAA therapy (per month: aHR=0.97; P=.006). Rates per 1000 person-months:
- ≥4 years: 0.08.
- 2-4 years: 0.37.
- 1-2 years: 0.48.
- Observational design, reliance on diagnostic codes.