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Gastroenterology. 2019 Jul 30. pii: S0016-5085(19)41137-2. doi: 10.1053/j.gastro.2019.07.040. [Epub ahead of print]

Direct-Acting Antiviral Therapy for HCV Infection is Associated with Increased Survival in Patients With a History of Hepatocellular Carcinoma.

Author information

1
Division of Digestive and Liver Disease, UT Southwestern Medical Center. Electronic address: amit.singal@utsouthwestern.edu.
2
Division of Digestive and Liver Disease, UT Southwestern Medical Center.
3
Division of Gastroenterology, University of California San Francisco.
4
Department of Medicine, Icahn School of Medicine at Mount Sinai.
5
Division of Gastroenterology, Hepatology and Nutrition, University of Chicago.
6
Division of Gastroenterology and Hepatology, University of Pennsylvania.
7
Transplantation Institute and Division of Gastroenterology, Loma Linda University Health.
8
Division of Hepatology, Loyola University Medical Center and Edward Hines Veterans Affairs.
9
Department of Transplantation, California Pacific Medical Center.
10
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine.
11
Toronto Center for Liver Disease, Toronto General Hospital.
12
Division of Gastroenterology and Hepatology, McGuire VA Medical Center.
13
Division of Organ Transplantation, Scripps Green Hospital.
14
Liver Institute at Methodist Dallas.
15
Division of Gastroenterology, Georgetown University Hospital.
16
Division of Gastroenterology and Hepatology, Duke University Health Center.
17
Division of Gastroenterology and Hepatology, Mayo Clinic.
18
Division of Gastroenterology and Hepatology, Oregon Health and Science University.
19
Division of Hepatology, University of Miami Miller School or Medicine.
20
Division of Hepatology, Northwestern University.
21
Division of Gastroenterology and Research and Development, Veterans Affairs Puget Sound Healthcare System and University of Washington.
22
Liver Disease and Transplant Center, Cedars-Sinai Medical Center.
23
Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center.
24
Division of Gastroenterology and Hepatology, Stanford University.
25
Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences.
26
Division of Gastroenterology and Hepatology, Henry Ford Hospital.
27
Division of Gastroenterology, Rush Medical College.
28
Division of Abdominal Transplantation, Baylor College of Medicine.
29
Division of Gastroenterology, Washington University School of Medicine.
30
Division of Hepatology, Donald and Barbara Zucker School of Medicine, Northshore University Hospital, Northwell Health, Manhasset, New York.
31
Department of Pathology, UT Southwestern Medical Center.
32
Division of Gastroenterology and Hepatology, Alameda Health System.
33
Division of Gastroenterology and Hepatology, University of Michigan.

Abstract

BACKGROUND & AIMS:

There is controversy over benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs vs patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy.

METHODS:

We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, trans-arterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 healthcare systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting.

RESULTS:

Of 797 patients with HCV-related HCC, 383 patients (48.1%) received DAA therapy and 414 patients (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow up, compared with 103 deaths during 526.6 person-years of follow up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% CI, 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio [HR], 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response (SVR) to DAA therapy; risk of death was reduced in patients with SVR to DAA therapy (HR, 0.29; 95% CI, 0.18-0.47) but not in patients without an SVR (HR, 1.13; 95% CI, 0.55-2.33).

CONCLUSIONS:

In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.

KEYWORDS:

HCC; hepatitis C; liver cancer; survival

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