Direct-acting antivirals lower mortality and recurrence in HCV-related hepatocellular carcinoma post liver resection: A multicenter international study
Recommended Citation
Choi WJ, Ivanics T, Claasen M, Magyar CTJ, Li Z, Tabrizian P, Rocha C, Myers B, O'Kane GM, Reig M, Ferrer Fàbrega J, Holgin V, Parikh ND, Pillai A, Hunold TM, Vogel A, Patel MS, Singal AG, Tadros M, Feld JJ, Hansen B, and Sapisochin G. Direct-acting antivirals lower mortality and recurrence in HCV-related hepatocellular carcinoma post liver resection: A multicenter international study. Surgery 2025;183:109396.
Document Type
Article
Publication Date
7-1-2025
Publication Title
Surgery
Keywords
Humans, Carcinoma, Hepatocellular, Liver Neoplasms, Male, Female, Antiviral Agents, Retrospective Studies, Middle Aged, Hepatectomy, Neoplasm Recurrence, Local, Aged, Postoperative Complications, Hepatitis C, Hepatitis C, Chronic
Abstract
BACKGROUND: The impact of treatment on hepatitis C virus with direct-acting antivirals on 90-day postoperative outcomes, overall survival, and recurrence-free survival in patients after liver resection for hepatocellular carcinoma is unknown.
METHODS: We conducted a multicenter retrospective study. Adults who underwent liver resection for hepatitis C virus-related hepatocellular carcinoma between January 2000 and December 2018 were included from 7 international institutions. Groups included direct-acting antiviral treated, non-direct-acting antiviral treated, and untreated hepatitis C virus infection. We used a multivariable model to evaluate the association between receipt of preoperative direct-acting antivirals and 90-day postoperative major complications (Clavien-Dindo class ≥ III).
RESULTS: We identified 738 patients, including 206 (28%) direct-acting antiviral treated, 241 (33%) non-direct-acting antiviral treated, and 291 (39%) untreated patients. The sustained virologic response rate was 92% in the direct-acting antiviral and 71% in the non-direct-acting antiviral treatment groups. The median follow-up was 7.6 years (95% confidence interval 6.1, 8.6) after surgery for the entire cohort. Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those without antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.26 [0.19, 0.35] and 0.52 [0.43, 0.64], respectively). Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those who received non-direct-acting antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.49 [0.36, 0.66] and 0.78 [0.63, 0.96], respectively). There was no significant association between preoperative direct-acting antiviral therapy and 90-day postoperative major complications (adjusted odds ratio 0.34, 95% confidence interval 0.08, 1.01).
CONCLUSION: Direct-acting antiviral therapy is associated with improved 5-year overall and recurrence-free survival, without significantly increased risk of 90-day postoperative complications, in patients undergoing liver resection for hepatitis C virus-related hepatocellular carcinoma.
Medical Subject Headings
Humans; Carcinoma; Hepatocellular; Liver Neoplasms; Male; Female; Antiviral Agents; Retrospective Studies; Middle Aged; Hepatectomy; Neoplasm Recurrence; Local; Aged; Postoperative Complications; Hepatitis C; Hepatitis C; Chronic
PubMed ID
40334495
Volume
183
First Page
109396
Last Page
109396
