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. 2025 Feb;45(2):e16185.
doi: 10.1111/liv.16185.

Absence of Viral Replication Is Associated With Improved Outcome in Anti-HCV-Positive Patients With Hepatocellular Carcinoma

Edoardo G Giannini  1   2 , Andrea Pasta  1 , Maria Corina Plaz Torres  1   2 , Giulia Pieri  1   2 , Giuseppe Cabibbo  3 , Angelo Sangiovanni  4 , Fabio Piscaglia  5   6 , Claudia Campani  7 , Gabriele Missale  8 , Gianpaolo Vidili  9 , Giorgia Ghittoni  10 , Filippo Pelizzaro  11 , Francesco Giuseppe Foschi  12 , Filomena Morisco  13 , Valentina Santi  14 , Gianluca Svegliati-Baroni  15 , Francesco Azzaroli  16 , Carlo Saitta  17 , Maurizia Rossana Brunetto  18 , Rodolfo Sacco  19 , Francesca Romana Ponziani  20 , Sara Boninsegna  21 , Gerardo Nardone  22 , Andrea Martini  23 , Andrea Mega  24 , David Sacerdoti  25 , Donatella Magalotti  26 , Alessandro Vitale  27 , Laura Bucci  14 , Franco Trevisani  14 ; Italian Liver Cancer (ITA.LI.CA) group
Collaborators, Affiliations

Absence of Viral Replication Is Associated With Improved Outcome in Anti-HCV-Positive Patients With Hepatocellular Carcinoma

Edoardo G Giannini et al. Liver Int. 2025 Feb.

Abstract

Background and aims: Presence of active hepatitis C virus (HCV) infection may influence the outcome of patients treated for hepatocellular carcinoma (HCC), although this issue has never been adequately assessed in a large series of patients. The aim of this study was to evaluate whether the presence of active HCV affects the survival of patients treated for HCC.

Methods: This study assessed the outcome of 3123 anti-HCV-positive patients with HCC, subdivided according to the presence of active HCV infection or previous sustained virological response (SVR). Comparisons were also carried out after propensity score matching (PSM) considering demographic, clinical and oncological characteristics.

Results: The median overall survival from HCC treatment was longer in patients with SVR than in those with active HCV infection both before (n = 2118: 61.0 months [95% confidence internal (CI): 56.5-65.5] vs. n = 1005: 51.0 months [95% CI: 43.4-58.6]; p = 0.003) and after PSM (n = 1285: 60.0 months [95% CI: 55.3-64.7] vs. n = 926: 54.0 months [95% CI: 46.7-61.3]; p = 0.030). Active HCV infection was associated with a greater risk of mortality (hazard ratio: 1.22-1.27, p = 0.001) independently of liver- and tumour-related variables, and modality of HCC treatment. Death due to liver failure was more common in patients with active HCV infection (24.5% vs. 17.1%; p = 0.001), while non-liver-related causes of death were more common in patients with SVR (25.0% vs. 17.0%; p = 0.001).

Conclusions: SVR is associated with a better outcome in patients undergoing HCC treatment, thus suggesting that these patients may benefit from antiviral therapy for HCV independently of cure of HCC.

Keywords: direct‐acting antivirals; outcome; response; survival; treatment.

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Conflict of interest statement

Edoardo G. Giannini. AstraZeneca, Roche: speaking and teaching; Ipsen: consultancy. Franco Trevisani. AbbVie, Astra Zeneca, Gilead, MSD, Roche: research grants; EISAI, Roche: advisory board. Filippo Pelizzaro. MSD advisory board. Andrea Pasta, Maria Corina Plaz Torres, Giulia Pieri, Giuseppe Cabibbo, Angelo Sangiovanni, Fabio Piscaglia, Claudia Campani, Gabriele Missale, Gianpaolo Vidili, Giorgia Ghittoni, Filippo Pelizzaro, Francesco Giuseppe Foschi, Filomena Morisco, Valentina Santi, Gianluca Svegliati‐Baroni, Francesco Azzaroli, Carlo Saitta, Maurizia Rossana Brunetto, Rodolfo Sacco, Antonio Gasbarrini, Sara Boninsegna, Gerardo Nardone, Andrea Martini, Andrea Mega, David Sacerdoti, Daniela Magalotti, Alessandro Vitale, Laura Bucci: nothing to declare.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves of patients according to viral status, before (A) and after (B) propensity score matching (PSM).
FIGURE 2
FIGURE 2
(A) Proportion and number of patients with progressive disease (PD), stable disease (SD) and objective response (OR) according to viral status. (B) Kaplan–Meier survival curves of patients with PD, SD and OR according to viral status.
FIGURE 3
FIGURE 3
Kaplan–Meier survival curves of all patients according to viral status per main treatment (A: liver transplantation; B: liver resection; C: ablative therapies; D: trans‐arterial therapies; E: systemic therapies; F: best supportive care).
See this image and copyright information in PMC

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