@article {221330, title = {Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis.}, journal = {Gut}, volume = {71}, year = {2022}, pages = {593-604}, abstract = {

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=74.6\%) and 5.7 (2.5 to 15.3, I=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.

}, author = {Sapena, Victor and Enea, Marco and Torres, Ferran and Celsa, Ciro and Rios, Jose and Rizzo, Giacomo Emanuele Maria and Nahon, Pierre and Mari{\~n}o, Zoe and Tateishi, Ryosuke and Minami, Tatsuya and Sangiovanni, Angelo and Forns, Xavier and Toyoda, Hidenori and Brillanti, Stefano and Conti, Fabio and Degasperi, Elisabetta and Yu, Ming-Lung and Tsai, Pei-Chien and Jean, Kevin and El Kassas, Mohamed and Hend Ibrahim Shousha and Omar, Ashraf and Zavaglia, Claudio and Nagata, Hiroko and Nakagawa, Mina and Asahina, Yasuhiro and Singal, Amit G and Murphy, Caitlin and Kohla, Mohamed and Masetti, Chiara and Dufour, Jean-Fran{\c c}ois and Merchante, Nicolas and Cavalletto, Luisa and Chemello, Liliana Lc and Pol, Stanislas and Crespo, Javier and Calleja, Jose Luis and Villani, Rosanna and Serviddio, Gaetano and Zanetto, Alberto and Shalaby, Sarah and Russo, Francesco Paolo and Bielen, Rob and Trevisani, Franco and Camm{\`a}, Calogero and Bruix, Jordi and Cabibbo, Giuseppe and Reig, Maria} }