Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients

Francesca Saviella Benanti, Ciro Celsa, Vincenza Calvaruso, Salvatore Petta, Margherita Rossi, Vito Di Marco, Calogero Camma', Antonio Craxi, Giuseppe Cabibbo, Anna Licata, Giuseppe Alaimo, Francesco Benanti, Gaetano Scifo, Salvatore Madonia, Giovanni Raimondo, Anna Licata, Alfonso Averna, Marco Distefano, Maria Antonietta Di Rosolini, Giovanni MazzolaTullio Prestileo, Maria Rita Cannavò, Licia Larocca, Fabio Cartabellotta, Ignazio Scalisi, Giuseppe Malizia, Irene Cacciola, Maurizio Russello, Gaetano Bertino, Franco Trevisani, Giovanni Squadrito, Angelo Scifo, Bianca Magro, Filippo Cacciola, Francesca Rini, Giovanni Malizia, Margherita Squadrito, Nicola Alessi, Salvatore Guastella

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34 Citations (Scopus)

Abstract

Background & Aims: The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV), following successful treatment of early hepatocellular carcinoma (HCC), has been studied extensively. However, the benefit in terms of overall survival (OS) remains to be conclusively demonstrated. The aim of this study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic decompensation. Methods: We prospectively enrolled 163 consecutive patients with HCV-related cirrhosis and a first diagnosis of early Barcelona Clinic Liver Cancer stage 0/A HCC, who had achieved a complete radiologic response after curative resection or ablation and were subsequently treated with DAAs. DAA-untreated patients from the ITA.LI.CA. cohort (n = 328) served as controls. After propensity score matching, outcomes of 102 DAA-treated (DAA group) and 102 DAA-untreated patients (No DAA group) were compared. Results: In the DAA group, 7/102 patients (6.9%) died, HCC recurred in 28/102 patients (27.5%) and hepatic decompensation occurred in 6/102 patients (5.9%), after a mean follow-up of 21.4 months. OS was significantly higher in the DAA group compared to the No DAA group (hazard ratio [HR] 0.39; 95% CI 0.17–0.91; p = 0.03). HCC recurrence was not significantly different between the DAA and No DAA groups (HR 0.70; 95% CI 0.44–1.13; p = 0.15). A significant reduction in the rate of hepatic decompensation was observed in the DAA group compared with the No DAA group (HR 0.32; 95% CI 0.13–0.84; p = 0.02). In the DAA group, sustained virologic response was a significant predictor of OS (HR 0.02; 95% CI 0.00–0.19; p <0.001), HCC recurrence (HR 0.25; 95% CI 0.11–0.57; p <0.001) and hepatic decompensation (HR 0.12; 95% CI 0.02–0.38; p = 0.02). Conclusions: In patients with HCV-related cirrhosis who had been successfully treated for early HCC, DAAs significantly improved OS compared with No DAA treatment. Lay summary: We aimed to determine whether direct-acting antivirals (DAAs) significantly improve overall survival in patients with hepatitis C virus-related compensated cirrhosis and a first diagnosis of hepatocellular carcinoma (HCC) which has been successfully treated with curative resection or ablation. Using propensity-score matched patients, we found that DAAs improved overall survival and reduced the risk of hepatic decompensation. However, the risk of HCC recurrence was not significantly reduced.
Original languageEnglish
Pages (from-to)265-273
Number of pages9
JournalJournal of Hepatology
Volume71
Publication statusPublished - 2019

All Science Journal Classification (ASJC) codes

  • Hepatology

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