N Saraiya1, A C Yopp2, N E Rich1, M Odewole1, N D Parikh3, A G Singal1,4. 1. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA. 2. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA. 3. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 4. Department of Clinical Sciences, University of Texas Southwestern, Dallas, TX, USA.
Abstract
BACKGROUND: Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct-acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response. AIM: Characterize HCC recurrence patterns after DAA therapy. METHODS: Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines. RESULTS: Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%-30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%-28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA-treated and interferon-treated or untreated patients found similar recurrence among DAA-treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow-up. CONCLUSIONS: Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.
BACKGROUND: Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct-acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response. AIM: Characterize HCC recurrence patterns after DAA therapy. METHODS: Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines. RESULTS: Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%-30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%-28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA-treated and interferon-treated or untreated patients found similar recurrence among DAA-treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow-up. CONCLUSIONS: Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.
Authors: Giuseppe Cabibbo; Salvatore Petta; Marco Barbara; Simona Attardo; Laura Bucci; Fabio Farinati; Edoardo G Giannini; Giulia Negrini; Francesca Ciccarese; Gian Lodovico Rapaccini; Maria Di Marco; Eugenio Caturelli; Marco Zoli; Franco Borzio; Rodolfo Sacco; Roberto Virdone; Fabio Marra; Andrea Mega; Filomena Morisco; Luisa Benvegnù; Antonio Gasbarrini; Gianluca Svegliati-Baroni; Francesco Giuseppe Foschi; Andrea Olivani; Alberto Masotto; Gerardo Nardone; Antonio Colecchia; Marcello Persico; Antonio Craxì; Franco Trevisani; Calogero Cammà Journal: J Hepatol Date: 2017-02-10 Impact factor: 25.083
Authors: Graham R Foster; William L Irving; Michelle C M Cheung; Alex J Walker; Benjamin E Hudson; Suman Verma; John McLauchlan; David J Mutimer; Ashley Brown; William T H Gelson; Douglas C MacDonald; Kosh Agarwal Journal: J Hepatol Date: 2016-01-30 Impact factor: 30.083
Authors: Amit G Singal; Nicole E Rich; Neil Mehta; Andrea D Branch; Anjana Pillai; Maarouf Hoteit; Michael Volk; Mobolaji Odewole; Steven Scaglione; Jennifer Guy; Adnan Said; Jordan J Feld; Binu V John; Catherine Frenette; Parvez Mantry; Amol S Rangnekar; Omobonike Oloruntoba; Michael Leise; Janice H Jou; Kalyan Ram Bhamidimarri; Laura Kulik; George N Ioannou; Annsa Huang; Tram Tran; Hrishikesh Samant; Renumathy Dhanasekaran; Andres Duarte-Rojo; Reena Salgia; Sheila Eswaran; Prasun Jalal; Avegail Flores; Sanjaya K Satapathy; Sofia Kagan; Purva Gopal; Robert Wong; Neehar D Parikh; Caitlin C Murphy Journal: Gastroenterology Date: 2019-07-30 Impact factor: 22.682
Authors: Amit G Singal; Nicole E Rich; Neil Mehta; Andrea Branch; Anjana Pillai; Maarouf Hoteit; Michael Volk; Mobolaji Odewole; Steven Scaglione; Jennifer Guy; Adnan Said; Jordan J Feld; Binu V John; Catherine Frenette; Parvez Mantry; Amol S Rangnekar; Omobonike Oloruntoba; Michael Leise; Janice H Jou; Kalyan Ram Bhamidimarri; Laura Kulik; Tram Tran; Hrishikesh Samant; Renumathy Dhanasekaran; Andres Duarte-Rojo; Reena Salgia; Sheila Eswaran; Prasun Jalal; Avegail Flores; Sanjaya K Satapathy; Robert Wong; Annsa Huang; Suresh Misra; Myron Schwartz; Robert Mitrani; Sasank Nakka; Wassim Noureddine; Chanda Ho; Venkata R Konjeti; Alexander Dao; Kevin Nelson; Kelly Delarosa; Usman Rahim; Meher Mavuram; Jesse J Xie; Caitlin C Murphy; Neehar D Parikh Journal: Gastroenterology Date: 2019-01-18 Impact factor: 22.682
Authors: Michael K Turgeon; Rachel M Lee; Adriana C Gamboa; Adam Yopp; Emily L Ryon; Neha Goel; Annie Wang; Ann Y Lee; Sommer Luu; Cary Hsu; Eric Silberfein; Shishir K Maithel; Maria C Russell Journal: HPB (Oxford) Date: 2020-08-07 Impact factor: 3.647