Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar;71(3):593-604.
doi: 10.1136/gutjnl-2020-323663. Epub 2021 Mar 19.

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis

Affiliations
Free article
Meta-Analysis

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis

Victor Sapena et al. Gut. 2022 Mar.
Free article

Abstract

Objective: The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration.

Design: We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson.

Results: Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1).

Conclusion: Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.

Keywords: antiviral therapy; hepatocellular carcinoma; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: VS: travel funding from Bayer. FT: DSMB fees from Basilea Pharmaceutica International and ROVI; educational fees from Janssen and Ferrer. PN: consults for AbbVie, AstraZeneca, Bayer, BMS, Eisai, Gilead, Ipsen, Roche. He received grants from AbbVie and BMS. ZM: speaker fees and consultancy for Gilead and AbbVie. RT: personal fees from Merk Sharp & Dorme, Giliad Sciences and AbbVie GK. TM: personal fees from Merk Sharp & Dorme, Giliad Sciences and AbbVie GK. XF: consultancy fees for AbbVie and Gilead Sciences. HT: speaker fees from AbbVie, Gildead, MSD and Bayer. SB: consultancy fees and educational grants from: Gilead Sciences, MSD, Intercept. ED: advisory board from AbbVie; speaking and teaching from Gilead, MSD, AbbVie. M-LY: research grant from Abbott, BMS, Gilead and Merck; consultant of AbbVie, Abbott, BMS, Gilead, Merck and Roche; speaker of AbbVie, Abbott, BMS, Gilead and Merck. YA: donation-funded department funded by Toray Industries Inc., Gilead Sciences, AbbVie GK and Fuji Rebio Inc. AS: has received research funding from AbbVie and Gilead. He has served as a consultant for Wako Diagnostics, Glycotest, Exact Sciences, Roche, GRAIL, Genentech, Bayer, Eisai, Exelixis, AstraZeneca, BMS and TARGET Pharmasolutions. MK: lecture fees from Abott and AstraZeneca. J-FD: advisory committees: AbbVie, Bayer, Bristol-Myers Squibb, Falk, Genfit, Genkyotex, Gilead Sciences, HepaRegenix, Intercept, Lilly, Merck, Novartis. Speaking and teaching: Bayer, Bristol-Myers Squibb, Intercept, Genfit, Gilead Sciences, Novartis, Roche. NM: research founding, lecture fees, advisory committees and travel grants from MSD. Lecture fees, advisory committees and travel grants from AbbVie and Gilead. SP: consulting and lecturing fees from Janssen, Gilead, MSD, AbbVie, Biotest, Shinogui, Viiv and grants from Bristol-Myers Squibb, Gilead, Roche and MSD, without relation to this manuscript. JC: grants and research support from Gilead Sciences, AbbVie, MSD, Shionogi and Intercept Pharmaceuticals (all outside the submitted work). Is a speaker for Gilead Sciences and AbbVie. JLC: reports grant support and/or consultancy and lecture fees from AbbVie, Gilead Sciences, Bristol-Myers Squibb, Janssen and MSD. RV: research grant from AbbVie. GS: consultancy fees and lecture fees from Gilead and AbbVie. FPR: lecture fees AbbVie, Gilead, MSD, Biotest; travel funds AbbVie, Biotest, Kedrion; research funds AbbVie, Gilead, MSD. RB: research grants from MSD, AbbVie and Gilead. JR: educational grants from Amgen, Grüenenthal Pharma, Boehringer Ingelheim España, Janssen-Cilag, Ferrer International, Lilly, Merck Sharp & Dohme and Roche Farma. FT: consultancy fees from AstraZeneca, Bayer, BMS, Eisai and Sirtex. Lecture fees from AlfaSigma and Bayer. Research grants from Bayer. CC: consultancy fees from Bayer, EISAI, MSD, Gilead, ABV. JB: consultancy fees from Arqule, Bayer, Novartis, BMS, BTG-Biocompatibles, Eisai, Kowa, Terumo, Gilead, Bio-Alliance/Onxeo, Roche, AbbVie, Merck, Sirtex, Ipsen, Astra-Medimmune, Incyte, Quirem, Adaptimmune, Lilly, Basilea, Nerviano. Research grants from Bayer and BTG. Educational grants from Bayer and BTG. Lecture fees from Bayer, BTG-Biocompatibles, Eisai, Terumo, Sirtex, Ipsen. GC: consultancy fees from Bayer, Ipsen. MR: consultancy fees from Bayer, BMS, Roche, Ipsen, AstraZeneca and Lilly. Lecture fees from Bayer, BMS, Gilead, Lilly and Roche. Research grants from Bayer and Ipsen.

Comment in

Similar articles

Cited by

Publication types

MeSH terms

Substances