Hepatocellular carcinoma (HCC) is a leading cause of liver-related death worldwide. Hepatitis C virus (HCV) infection is a major cause of advanced hepatic fibrosis and cirrhosis, with significantly increased risk for development of HCC. The morbidity and mortality of HCV-related HCC remains high, as rates of HCV cirrhosis continue to increase. The long-term goal of antiviral therapy for chronic HCV is to reduce complications from cirrhosis, including HCC. The advent of new direct-acting antivirals with high rates of virological clearance has revolutionized cure of HCV infection. While the development of HCC in HCV patients who achieve disease sustained virologic response is reduced, these patients remain at risk for HCC, particularly those patients with advanced fibrosis and cirrhosis. This review outlines the epidemiology of HCC in chronic HCV, various mechanisms, risk factors and pathophysiology that contribute to this disease process, screening recommendations, and the available data on the impact of new direct-acting antiviral treatment on the development on HCC.

/pdf/hepatitis-c-virus-and-hepatocellular-carcinoma-a-narrative-pimg6145t0.pdf

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

AGA Clinical Practice Update on Interaction Between Oral Direct-Acting Antivirals for Chronic Hepatitis C Infection and Hepatocellular Carcinoma: Expert Review

Fibrosis Regression After Eradication of Hepatitis C Virus: From Bench to Bedside

Background Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct-acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response. Aim Characterize HCC recurrence patterns after DAA therapy. Methods Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines. Results Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%-30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%-28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA-treated and interferon-treated or untreated patients found similar recurrence among DAA-treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow-up. Conclusions Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.

/pdf/systematic-review-with-meta-analysis-recurrence-of-3rcuymi7hy.pdf

Systematic review with meta-analysis: recurrence of hepatocellular carcinoma following direct-acting antiviral therapy.

Immune inflammation indicators and ALBI score to predict liver cancer in HCV-patients treated with direct-acting antivirals.

Recently, concerns were raised of high rates of HCC recurrence in patients treated with direct-acting antivirals (DAA) for hepatitis C infection We investigated the HCC occurrence and recurrence rates within 6 months after treatment with DAA with or without pegylated interferon (PEG-IFN) in real life This is a retrospective, multicenter cohort trial, executed in 15 hospitals distributed across Belgium Populations were matched based on fibrosis score (Metavir F3-F4) Patients with a Child-Pugh score >= B were excluded In total, 567 patients were included, of whom 77 were treated with PEG-IFN+DAA between 2008 and 2013 and 490 with DAA without PEG-IFN between 2013 and 2015 Patients treated with PEG-IFN+DAA (53 +/- 9y) were younger than patients treated with DAA without PEG-IFN (59 +/- 12y) (P= 001) 47% of patients treated with PEG-IFN+DAA were in the F4 stage vs 67% of patients treated with DAA without PEG-IFN (P= 001) Screening was inadequate in 20% of both patient groups (P= 664) The early occurrence rate of HCC was 17% and 11% in patients treated with DAA with and without PEG-IFN, respectively (P= 540) The early recurrence rate was 0% in patients treated with PEG-IFN+DAA and 150% in patients treated with DAA without PEG-IFN (P= 857) There is no difference in early occurrence of new HCC between patients treated with DAA with and without PEG-IFN We did observe a high early recurrence rate of HCC in patients treated with DAA without PEG-IFN However, these patients were at baseline more at risk for HCC Finally, in 20%, screening for HCC was inadequate

/pdf/the-risk-of-early-occurrence-and-recurrence-of-3ns8pp60r8.pdf

The risk of early occurrence and recurrence of hepatocellular carcinoma in hepatitis C infected patients treated with direct acting antivirals with and without pegylated interferon: a Belgian experience

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The risk of early occurrence and recurrence of hepatocellular carcinoma in hepatitis C infected patients treated with direct acting antivirals with and without pegylated interferon: a Belgian experience