Dong Hyun Sinn1, Seung Up Kim2, Hye Kyung Hyun3, Eun Ju Cho4, Soo Young Park5, Young Mi Hong6, Soon Sun Kim7, Hwi Young Kim8, Nae-Yun Heo9, Jung Gil Park10, Wonseok Kang1, Song Won Jeong11, Myeong Jun Song12, Hana Park13, Danbi Lee13, Yong Sun Lee14, Sung Bum Cho15, Chan Sik An3, Hyung Jin Rhee3, Hyun Woong Lee3, Beom Kyung Kim3, Jun Yong Park3, Do Young Kim3, Sang Hoon Ahn3, Kwang-Hyub Han3, Jeong-Hoon Lee4, Su Jong Yu4, Yoon Jun Kim4, Jung-Hwan Yoon4, Won Young Tak5, Young Oh Kweon5, Ki Tae Yoon6, Mong Cho6, Jae Youn Cheong7, Seung Ha Park9. 1. Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine, Yonsei Liver Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. KSUKOREA@yuhs.ac. 3. Department of Internal Medicine, Yonsei Liver Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. 4. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. 5. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 6. Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. 7. Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea. 8. Department of Internal Medicine, College of Medicine, Ewha Woman University, Seoul, Republic of Korea. 9. Departments of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea. 10. Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea. 11. Department of Internal Medicine, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Republic of Korea. 12. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 13. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 14. Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. 15. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Abstract
BACKGROUND AND AIMS: The influence of direct-acting antivirals (DAAs) on chronic hepatitis C (CHC)-related hepatocellular carcinoma (HCC) remains controversial. We investigated the effect of eradicating CHC using DAAs on treatment outcomes in patients with CHC-related HCC treated with transarterial chemoembolization (TACE). METHODS: This nationwide, multi-center, retrospective study recruited patients with CHC-related HCC treated with TACE as the first-line anti-cancer treatment, and who achieved a sustained virological response (SVR) using DAAs (DAA group) between 2006 and 2017. Patients achieving an SVR following interferon-based treatment (IFN group) and those without treatment (control group) were also recruited for comparison. RESULTS: A total of 425 patients were eligible for the study. Of these, 356 (83.8%), 26 (6.1%), and 43 (10.1%) were allocated to the control, IFN, and DAA groups, respectively. A multivariate analysis showed that liver cirrhosis, segmental portal vein thrombosis, and larger maximal tumor size independently predicted an increased risk of progression (all p < 0.05), whereas, the DAA group (vs. IFN and control groups) independently predicted a reduced risk of progression (hazard ratio (HR) = 0.630, 95% confidence interval 0.411-0.966, p = 0.034). The cumulative incidence rate of HCC progression in the DAA group was significantly lower than that in the IFN and control groups (p = 0.033, log-rank test). In addition, the DAA group (vs. IFN and control groups) was independently associated with a reduced risk of mortality (p = 0.042). CONCLUSIONS: DAA treatment provided significantly prolonged progression-free survival in patients with CHC-related HCC treated with TACE compared to that in patients administered IFN or no treatment.
BACKGROUND AND AIMS: The influence of direct-acting antivirals (DAAs) on chronic hepatitis C (CHC)-related hepatocellular carcinoma (HCC) remains controversial. We investigated the effect of eradicating CHC using DAAs on treatment outcomes in patients with CHC-related HCC treated with transarterial chemoembolization (TACE). METHODS: This nationwide, multi-center, retrospective study recruited patients with CHC-related HCC treated with TACE as the first-line anti-cancer treatment, and who achieved a sustained virological response (SVR) using DAAs (DAA group) between 2006 and 2017. Patients achieving an SVR following interferon-based treatment (IFN group) and those without treatment (control group) were also recruited for comparison. RESULTS: A total of 425 patients were eligible for the study. Of these, 356 (83.8%), 26 (6.1%), and 43 (10.1%) were allocated to the control, IFN, and DAA groups, respectively. A multivariate analysis showed that liver cirrhosis, segmental portal vein thrombosis, and larger maximal tumor size independently predicted an increased risk of progression (all p < 0.05), whereas, the DAA group (vs. IFN and control groups) independently predicted a reduced risk of progression (hazard ratio (HR) = 0.630, 95% confidence interval 0.411-0.966, p = 0.034). The cumulative incidence rate of HCC progression in the DAA group was significantly lower than that in the IFN and control groups (p = 0.033, log-rank test). In addition, the DAA group (vs. IFN and control groups) was independently associated with a reduced risk of mortality (p = 0.042). CONCLUSIONS:DAA treatment provided significantly prolonged progression-free survival in patients with CHC-related HCC treated with TACE compared to that in patients administered IFN or no treatment.
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