ABSTRACT
Background
There are many contradictory studies that dealt with hepatocellular carcinoma (HCC) recurrence rate of well ablated hepatitis C virus (HCV) related HCC. We aim to assess the recurrence rate of previously ablated HCC in patients who received direct acting antiviral (DAA) for their HCV.
Research design and methods
This is a retrospective data analysis of 523 HCV patients who have a history of successfully ablated HCC and eligible for HCV treatment. Retrieval was done to demographic/clinical data, HCV pretreatment investigations, HCV treatment outcome. Follow up for survival and HCC recurrence was done every 3 months using abdominal ultrasound and alfa-fetoprotein.
Results
Mean age was 53.83 years. Sofosbuvir/daclatasvir/ribavirin was the most used regimen (35.4%) with 438 patients (83.7%) achieved sustained virologic response (SVR). The median duration for surveillance was 159 weeks. Hundred and five patients developed recurrent HCC, with a crude recurrence rate of 20.1%. There was no difference between HCV responders and non-responders in crude recurrence rate (p = 0.94) but HCC developed earlier in non-responders (p = <0.01).
Conclusion
Recurrence of HCC remains a threat in HCV patients even after achieving an SVR. Implementation of long-term surveillance programs is highly recommended.
KEYWORDS:
List of abbreviations
ALT: Alanine aminotransferase
AFP: Alpha fetoprotein
AST: Aspartate aminotransferases
BMI: Body mass index
DAAs: Direct acting antivirals
DCV: Daclatasvir
FIB-4: The fibrosis 4 score
HBA1C: Glycosylated hemoglobin
HCV: Chronic hepatitis C virus
HCC: Hepatocellular carcinoma
IFN: Interferon
LED: Ledipasvir
LLOQ: Lower limit of quantitation
NCCVH: The National Committee for Control of Viral Hepatitis
PAR/OMB paritaprevir-ritonavir-ombitasvir
PEG: Pegylated interferon
RVB: Ribavirin
SMV: Simeprevir
SOF: Sofosbuvir
SVR: Sustained virological response
TACE: Trans-arterial chemo-embolization
Ethics approval
Approval was granted by the ethics committee of the national committee for control of viral hepatitis, Ministry of Health and population Egypt. All patients signed an informed consent before receiving treatment allowing the use of their anonymous data and results for publication.
Reviewer disclosures
A reviewer on this manuscript has disclosed that they have received fees for lecturing from Gilead, BMS, Merck, Abbvie and for consulting and lecturing from Janssen. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.
Significance Statement
Patients with history of hepatocellular carcinoma (HCC) remain at risk of HCC recurrence even after receiving treatment by anti-HCV direct acting antivirals and achieving viral clearance. This necessitates to perform long-term follow up for these patients with a shorter time interval for early detection of any recurrent lesion.
Declaration of interest
Wahid Doss: investigator/speaker: Gilead Sciences. Gamal Esmat: investigator/speaker/advisory board member: Abbvie, Gilead Sciences, Marcyrl, Pharco, Roche. Imam Waked: Investigator/speaker/advisory board member: Abbvie, Eva Pharma, Gilead Sciences, Janssen, Marcyrl, Onxio, Pharco, Roche. The other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties apart from those disclosed.
Author contributions
All authors have substantially contributed to the conception and design of the review article and interpreting the relevant literature, and been involved in writing the review article or revised it for intellectual content.