Hepatocellular carcinoma recurrence in HCV patients treated with direct-acting antivirals after curative treatment

Aim: The increased risk of hepatocellular carcinoma (HCC) recurrence in hepatitis C virus (HCV)-infected patients treated with direct-acting antivirals (DAAs) after curative treatment for HCC is controversial. The purpose of this study was to examine the risk of HCC recurrence after DAA therapy.Methods: We conducted a retrospective cohort study of 312 consecutive patients with HCV-related HCC who received DAA therapy in participating institutions between September 2014 and July 2016. All patients received curative hepatectomy or radio-frequency ablation. We calculated the annual incidence of HCC recurrence after DAA therapy and identified the risk factors for HCC recurrence using Cox regression models.Results: The median age was 74 years old, and a sustained virological response was achieved by 288 patients. The 3-year-overall survival rate was 95.4% in a median follow-up period of 855 days. HCC recurred in 135 patients. The 1-, 2- and 3-year recurrence rates were 18.3%, 38.8% and 55.4%, respectively. A multivariate analysis revealed that the following factors were associated with HCC recurrence: multiple tumors at the first HCC treatment [hazard ratio (HR) = 2.21; 95%CI: 1.41-3.49], a history of multiple treatments for HCC (HR = 1.97; 95%CI: 1.28-3.02), and α-fetoprotein (AFP-L3) ≥ 10% at the initiation of DAA therapy (HR = 4.74; 95%CI: 2.10-10.7).Conclusion: Among patients treated with DAAs after the curative treatment of HCC, multiple tumors at the first HCC treatment, multiple prior HCC treatments and a high AFP-L3 level before DAA therapy were associated with recurrence, and the rate of recurrence was comparable to that before the DAA era