Direct-acting antivirals improve survival and recurrence rates after treatment of hepatocellular carcinoma within the Mi
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Direct-acting antivirals improve survival and recurrence rates after treatment of hepatocellular carcinoma within the Milan criteria Hironori Ochi1 • Atsushi Hiraoka2 • Masashi Hirooka3 • Yohei Koizumi3 • Michiko Amano1 • Nobuaki Azemoto1 • Takao Watanabe3 • Osamu Yoshida3 • Yoshio Tokumoto3 • Toshie Mashiba1 • Tomoyuki Yokota1 • Masanori Abe3 • Kojiro Michitaka2 • Yoichi Hiasa3 • Kouji Joko1 Received: 20 May 2020 / Accepted: 29 October 2020 Ó The Author(s) 2020
Abstract Background The effects of direct-acting antivirals (DAAs) on survival and recurrence rates after curative hepatocellular carcinoma (HCC) treatment in patients with hepatitis C virus (HCV) infection remain controversial. Methods This retrospective, multicenter study involved Child–Pugh class A patients within the Milan criteria who had a first diagnosis of HCC and survived 6 months or longer after undergoing hepatectomy or radiofrequency ablation (RFA). The DAA-treated group (DAA group) included 56 patients, and the DAA-untreated group (untreated group) included 261 patients. The study was conducted using the propensity score-matched (1:2) DAA group and untreated group, 56 and 112 patients, respectively. Results The survival rate at 48 months in the DAA group and the untreated group was 91.0% and 68.7%, respectively, showing significantly better survival in the DAA group (HR: 0.33; 95% CI 0.13–0.84; p = 0.021). The recurrence rate at 48 months was 36.7% and 66.7%, respectively, showing a significantly lower recurrence rate Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01747-y) contains supplementary material, which is available to authorized users. & Kouji Joko [email protected] 1
Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, Ehime, Japan
2
Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime, Japan
3
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
in the DAA group (HR, 0.46; 95% CI 0.27–0.77; p = 0.003). The median albumin–bilirubin (ALBI) score at 3 years post-HCC treatment was - 2.84 in the DAA group and - 2.34 in the untreated group. The ALBI score showed a significant improvement from baseline to 3 years postHCC treatment (p = 0.001), whereas that in the untreated group showed a significant decline (p = 0.040). Conclusions DAAs after HCC treatment prevents deterioration of hepatic functional reserve and significantly improves both recurrence and survival rates. Keywords Hepatocellular carcinoma Direct-acting antivirals Hepatitis C virus Hepatic functional reserve
Introduction Hepatitis C virus (HCV) infection affects an estimated 1.8 million people globally and is the leading cause of hepatocellular carcinoma (HCC) [1]. Reports have indicated that the most serious outcome of HCV infection is hepatocarcinogenesis or progressive hepatic failure
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