Background/Aim There has been a long-standing debate about the association of directacting antiviral (DAA) therapy and hepatocellular carcinoma (HCC) recurrence. This study aimed to investigate the association between DAA therapy and HCC recurrence after curative therapy.
Methods We retrospectively enrolled 1,021 patients with HCV-related (hepatitis C virus) HCC who underwent radiofrequency ablation (RFA), liver resection, or both as the first treatment modality from January 2007 to December 2016 and without a history of HCV therapy before HCC treatment from a nationwide database. The effect of HCV treatment on HCC recurrence and all-cause mortality was also investigated.
Results Among the 1,021 patients, 77 (7.5%) were treated with DAA, 14 (1.4%) were treated with interferon-based therapy, and 930 (91.1%) did not receive HCV therapy. DAA therapy was an independent prognostic factor for lower HCC recurrence rate (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.006-0.289; P=0.001 for landmarks at 6 months after HCC treatment and HR, 0.05; 95% CI, 0.007-0.354; P=0.003 for landmarks at 1 year). Furthermore, DAA therapy was associated with lower all-cause mortality (HR, 0.049; 95% CI, 0.007-0.349; P=0.003 for landmarks at 6 months and HR, 0.063; 95% CI, 0.009-0.451; P=0.006 for landmarks at 1 year).
Conclusions DAA therapy after curative HCC treatment can decrease HCC recurrence and all-cause mortality compared to interferon-based therapy or no antiviral therapy. Therefore, clinicians should consider administering DAA therapy after curative HCC treatment in patients with HCV-related HCC.
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Background/Aims Tenofovir disoproxil fumarate (TDF) is potentially nephrotoxic in chronic hepatitis B patients. Hepatocellular carcinoma (HCC) patients treated using transarterial chemoembolization (TACE) are at an increased risk of renal injury. The aim of this study was to determine whether TDF is associated with more renal adverse events than entecavir (ETV) in HCC patients treated with TACE.
Methods In this retrospective single-center study, we selected 53 HCC patients who were treated with TDF from January 2012 to July 2013 and had their first TACE procedure in the same period. These patients were matched by age and sex to patients treated with ETV.
Results There were no significant differences in baseline characteristics, including HCC factors, and nephrotoxic drug use, between the two groups. The median follow-up period was 17.0 and 20.0 months for the TDF and ETV groups, respectively. There was no difference during the follow-up period between the TDF and ETV groups in the increase in creatinine over 0.5 mg/dL (17.0% and 17.0%, P=1.00, respectively) and the decrease in eGFR over 25% (43.4% and 41.5%, P=0.84, respectively). Multivariate analysis revealed that Child-Pugh class over B (hazard ratio [HR], 7.30; 95% confidence interval [CI] 2.79-19.10; P<0.01) was associated with increase in creatinine, and Child-Pugh class over B (HR, 82.74; 95% CI 12.31-555.83; P<0.01) and Barcelona-Clinic Liver Cancer stage over B (HR, 14.93; 95% CI 1.60-139.51; P=0.02) were associated with decrease in eGFR.
Conclusions TDF has comparable safety to that of ETV for HCC patients undergoing TACE.
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Background/Aims Nucleos(t)ide analogues (NAs) help reduce the recurrence rate after
the curative treatment of hepatitis B related hepatocellular carcinoma (HCC). Sorafenib has
been shown to improve survival of advanced HCC patients. Whether antiviral therapy with
NAs could help such patients is unknown. Our aim is to investigate the usefulness of antiviral
therapy for advanced-stage HCC treated with sorafenib.
Methods We performed a retrospective cohort study in advanced-stage HCC patients
treated with sorafenib between June 2007 and December 2013. Patients in group A (the nonantiviral
therapy group) were treated with sorafenib alone. Those in group B (the antiviral
therapy group) were treated with sorafenib and NAs. Progression-free survival (PS) and overall
survival (OS) were compared between these two groups.
Results Finally, 23 patients in group A and 40 patients in group B were enrolled in the study.
The mean number of days of treatment with sorafenib was 79 (34-231) days and 96 (33-449)
days for group A and B, respectively (P=0.286). The mean PS of group A and B was 97 (14-449)
days and 51 (0-461) days, respectively (P=0.068). The OS was 154 (44-741) days in group A and
138 (30-1,025) days in group B (P=0.665). PS and OS showed no significant difference between
the two groups.
Conclusions This study shows that there was no significant survival gain of using antiviral
therapy in patients with advanced-stage HCC treated with sorafenib. In consideration of costeffectiveness,
antiviral therapy may be not mandatory. (J Liver Cancer 2016;16:23-30)