Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1743
Peer-review started: April 15, 2021
First decision: June 15, 2021
Revised: June 30, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 27, 2021
The evidence on the link between direct-acting antivirals (DAAs) and the development of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) patients is insufficient and conflicting.
Due to unmet needs for early HCC detection and care, post-treatment HCV-related HCC is an increasing concern.
To compare fundamental clinical, radiographic, and laboratory features and tumor behavior in individuals with and without a history of DAAs exposure after HCC diagnosis.
A multicenter case-control study including 497 patients with chronic HCV-related HCC, allocated into one of two groups according to their history of antiviral treatment for their HCV.
Group I consisted of 151 HCC patients who had previously been treated with DAAs, while group II included 346 patients who had never been treated with DAAs. Regarding basic assessment scores (Child, MELD, and BCLC), there was a substantial difference between the two groups, with group I showing a tendency for more advanced liver disease and HCC stage at diagnosis. However, serum albumin levels were considerably lower in group II, and serum-fetoprotein levels were significantly greater (P = 0.001). In addition, HCC multicentricity was substantially higher in group I than in group II, and the rate of portal vein thrombosis was significantly higher in group I (P = 0.001).
HCC patients who are naïve to DAAs have more advanced clinical scores and laboratory features than those who have never been treated with DAAs; yet, HCC behavior is more aggressive in DAA-treated patients.
The findings of this study warrant additional investigation in prospective trials with larger cohorts and longer follow-up for comparing survival and proactive screening for HCC in HCV-treated patients through public or private pharmacovigilance programs.