Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1743-1752
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1743
Tumor characteristics of hepatocellular carcinoma after direct-acting antiviral treatment for hepatitis C: Comparative analysis with antiviral therapy-naive patients
Magdy Fouad, Mohamed El Kassas, Elham Ahmed, Reem El Sheemy
Magdy Fouad, Department of Tropical Medicine and Gastroenterology, Minia University, Minia 61519, Egypt
Mohamed El Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Elham Ahmed, Department of Internal Medicine, Minia University, Minia 61519, Egypt
Reem El Sheemy, Department of Tropical Medicine, Minia University, Minia 61111, Egypt
Author contributions: Fouad M and El Kassas M conceptualized the idea and design; El Sheemy R drafted, revised and edited the manuscript; all authors participated in and supervised patients’ treatment and follow-up, revised and approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the Institutional Research Board at the Faculty of Medicine, Minia University, Egypt. Informed written consent was obtained from all patients of the study. This research was performed in agreement with the guidelines of the 1975 Declaration of Helsinki.
Informed consent statement: Informed consent was obtained from all individual participants included in the study
Conflict-of-interest statement: All authors declare that they do not have any conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohamed El Kassas, MD, Associate Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt.
Received: April 15, 2021
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
Research background

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.

Research motivation

Due to unmet needs for early HCC detection and care, post-treatment HCV-related HCC is an increasing concern.

Research objectives

To compare fundamental clinical, radiographic, and laboratory features and tumor behavior in individuals with and without a history of DAAs exposure after HCC diagnosis.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.