Hepatocellular Carcinoma Recurrence after Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C: A Korean Multi-Center Retrospective Study

Abstract

Aims: The risk factor of hepatocellular carcinoma (HCC) recurrence following direct-acting antiviral (DAA) therapy remains unclear. The aims: of this study were to estimate the rate of HCC recurrence following DAA therapy in Korean patients with chronic hepatitis C (CHC), and to evaluate the risk factors for HCC recurrence after DAA therapy. Methods: A total of 103 participants with CHC who obtained complete response after HCC treatment were treated with DAA between August 2015 and December 2016 and were followed up until January 2018. HCC treatments were classified as potentially curative included liver resection, radiofrequency ablation, percutaneous ethanol injection, cryoablation and liver transplantation. Results: Among 103 patients, 82 patients had cirrhosis (79.2%) and 98 patients had Child-Pugh class A (95.1%). HCC stage of the patients was 49.6%, 38.9%, 9.7%, and 2.0% at stage I, II, III, and IV, respectively, according to modified UICC classification. Total duration of HCC treatment was median 2.3 (range, 0.03– 143.0) months, and interval from last HCC treatment to start of DAA therapy was median 12.6 (range, 1.5–28.6) months. During the median 15.7 (range, 4.3–29.9) months follow-up, 38 patients (36.9%) experienced tumor recurrence. The median time to recurrence was 22.8 months. The univariate analyses showed that lower platelet count, non-curative HCC treatment, shorter interval from HCC treatment to DAA therapy and longer total HCC treatment duration could be the risk factors for HCC recurrence. In multivariate analysis, shorter interval from HCC treatment to DAA therapy (<12 months) and longer total HCC treatment duration (≥18 months) were found to be the independent risk factors for HCC recurrence (hazard ratio [HR], 2.76; 95% confidence interval [CI], 1.21–6.30; P=0.016 and HR, 1.96; 95% CI, 1.00–3.83; P=0.049, respectively). Conclusions: In CHC patients with HCC, DAA therapy should be cautiously performed after sufficient interval without recurrence after complete treatment response.