Author information
1
The Kirby Institute, UNSW Sydney, Sydney, Australia. Electronic address: rwaziry@kirby.unsw.edu.au.
2
The Kirby Institute, UNSW Sydney, Sydney, Australia.
3
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
4
St Vincent's Clinical School, UNSW Sydney, Australia.
5
Storr Liver Centre, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND:
Risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) HCV therapy remains unclear. The aims of this study were: 1) In patients with HCV-related cirrhosis, to compare the rate of HCC occurrence following DAA versus interferon (IFN)-based cure, and; 2) In patients who received curative HCC treatment, to compare rate of HCC recurrence following DAA versus IFN-based cure.
METHODS:
A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person years (py) among patients with a sustained virological response (SVR).
RESULTS:
A total of 41 studies (n=13,875 patients), including 26 on HCC occurrence (IFN=17, DAA=9; prospective=19, retrospective=5, retrospective-prospective=2), and 17 on HCC recurrence (IFN=7, DAA=10; prospective=11, retrospective=5 and retrospective-prospective=1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 versus 5.5 years), and average age older (60 versus 52 years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 versus 5.0 years), but average age similar (64 versus 66 years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86, 1.52) and 2.96/100 py (95% CI 1.76, 4.96) in IFN and DAA studies. HCC recurrence was 9.21/100 py (95% CI 7.18, 11.81) and 12.16/100 py (95% CI 5.00, 29.58) in IFN and DAA studies. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68, 95% CI 0.18, 2.55, P=0.55) or recurrence (RR 0.62, 95% CI 0.11, 3.45, P=0.56).
CONCLUSION:
There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy.