Incidence of HCC recurrence after DAA treatment for HCV in a multicentre Italian cohort study

Background and aim

The present real-life multicentre, prospective study aims to investigate the effects of direct-acting antivirals (DAAs) in HCV patients with a previous successfully treated hepatocellular carcinoma (HCC), in terms of neoplastic recurrence and sustained virological response (SVR) rates.

Methods

From March 2015 to March 2017, all consecutive HCV patients with a previous successfully treated HCC who underwent DAA therapy were enrolled. Neoplastic recurrence was used as the primary outcome, whereas the secondary outcomes were patient characteristics predicting HCC recurrence. Cumulative probabilities of recurrence were extracted from time-to-event curves based on the Kaplan-Meier method. Hazard ratios with 95% confidence intervals were estimated using univariate and multivariate Cox regressions.

Results

A total of 101 patients were enrolled: 83% of them were in Child-Pugh class A, 88% had a history of HCC BCLC stage 0/A and 91.1% achieved SVR. The median time from the last successful HCC treatment to DAA start was 10.1 months [IQR: 5.6-16.7]. Thirty-one HCC recurrences were observed from DAA start (median follow-up: 31.7 months). The incidence rate of recurrence was 20.5/100 person-years. The 6-, 12- and 24-months HCC recurrence rates from the last HCC treatment were 1%, 8.9% and 25.6% respectively. DAA treatment failure, higher level of total bilirubin, higher BMI and higher level of AFP were significantly associated with higher risk of HCC recurrence in both univariate and Cox multivariate analysis.

Conclusions

Our data suggest that the achievement of SVR and the absence of well-known HCC risk factors reduce  recurrence in patients who have taken DAAs.