TY - JOUR
T1 - Hepatocellular carcinoma recurrence after direct-acting antiviral therapy
T2 - An individual patient data meta-analysis
AU - Sapena, Victor
AU - Enea, Marco
AU - Torres, Ferran
AU - Celsa, Ciro
AU - Rios, Jose
AU - Rizzo, Giacomo Emanuele Maria
AU - Nahon, Pierre
AU - Mariño, Zoe
AU - Tateishi, Ryosuke
AU - Minami, Tatsuya
AU - Sangiovanni, Angelo
AU - Forns, Xavier
AU - Toyoda, Hidenori
AU - Brillanti, Stefano
AU - Conti, Fabio
AU - Degasperi, Elisabetta
AU - Yu, Ming Lung
AU - Tsai, Pei Chien
AU - Jean, Kevin
AU - El Kassas, Mohamed
AU - Shousha, Hend Ibrahim
AU - Omar, Ashraf
AU - Zavaglia, Claudio
AU - Nagata, Hiroko
AU - Nakagawa, Mina
AU - Asahina, Yasuhiro
AU - Singal, Amit G.
AU - Murphy, Caitlin
AU - Kohla, Mohamed
AU - Masetti, Chiara
AU - Dufour, Jean François
AU - Merchante, Nicolas
AU - Cavalletto, Luisa
AU - Chemello, Liliana L.C.
AU - Pol, Stanislas
AU - Crespo, Javier
AU - Calleja, Jose Luis
AU - Villani, Rosanna
AU - Serviddio, Gaetano
AU - Zanetto, Alberto
AU - Shalaby, Sarah
AU - Russo, Francesco Paolo
AU - Bielen, Rob
AU - Trevisani, Franco
AU - Cammà, Calogero
AU - Bruix, Jordi
AU - Cabibbo, Giuseppe
AU - Reig, Maria
N1 - Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - 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, I 2 =74.6%) and 5.7 (2.5 to 15.3, I 2 =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.
AB - 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, I 2 =74.6%) and 5.7 (2.5 to 15.3, I 2 =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.
KW - antiviral therapy
KW - hepatocellular carcinoma
KW - meta-analysis
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U2 - 10.1136/gutjnl-2020-323663
DO - 10.1136/gutjnl-2020-323663
M3 - Article
C2 - 33741640
AN - SCOPUS:85103224322
SN - 0017-5749
VL - 71
SP - 593
EP - 604
JO - Gut
JF - Gut
IS - 3
ER -