1. Improved outcomes of liver resection for hepatitis C-related hepatocellular carcinoma after the introduction of direct-acting antiviral therapy.
- Author
-
Rocha C, Di Norcia J, Tabrizian P, Di Renzo C, Amodeo S, Bekki Y, Akhtar MZ, Facciuto ME, Schiano TD, Florman S, and Schwartz M
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Treatment Outcome, Retrospective Studies, Time Factors, Neoplasm Recurrence, Local, Hepatitis C complications, Hepatitis C drug therapy, Hepatitis C mortality, Risk Factors, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Liver Neoplasms surgery, Liver Neoplasms virology, Liver Neoplasms mortality, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular virology, Antiviral Agents therapeutic use, Hepatectomy, Sustained Virologic Response
- Abstract
Background: Assess impact of direct-acting antivirals introduction on outcomes after liver resection for hepatocellular carcinoma., Methods: 391 patients (1991-2021) treated with resection for hepatocellular carcinoma on Hepatitis C background were divided according to receiving Hepatitis C treatment, treatment type, achievement of sustained virological response (SVR), time of resection pre- (Era 1, 1991-2011) and post-direct acting antivirals introduction (Era 2, 2012-2021). Survival was estimated with Kaplan-Meier curves, Cox regression analysis performed to identify survival predictors., Results: Majority of patients had single lesion (67.8%), diameter >2 cm in 60.6%, no evidence of macroscopic vascular invasion on imaging. Pathology showed vascular invasion in 69.6% of patients, 76.5% microvascular. Recurrence developed in 247 patients (63.2%). 194 patients (49.6%) achieved SVR. Overall survival at 1-, 3-, 5-years was 94.6%, 85.7%, 78.8% for patients who achieved SVR, 80.1%, 48.1%, 29.9% in those who did not (p < 0.001). 220 patients (56.3%) were in Era 1, 171 (43.7%) in Era 2. Survival at 1-, 3-, 5-years was 76.1%, 49%, 36% in Era 1, 94.5%, 82.5%, 70.3% in Era 2 (p < 0.001). SVR was an independent predictor of survival on multiple Cox Regression analysis., Conclusion: While many aspects of HCC management have evolved, SVR following direct-acting antivirals independently improves HCC resection outcomes., Competing Interests: Conflict of interest Chiara Rocha MD, Joseph Di Norcia MD, Chiara Di Renzo MD, Salvatore Amodeo MD, Yuki Bekki MD PhD, M Zeeshan Akhtar BM BCh DPhil FRCS: none. Parissa Tabrizian MD MSc FACS: scientific consultant for Bayer, AstraZeneca, Boston Scientific., (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF