Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma.
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Singal Amit G, Rich Nicole E, Mehta Neil, Branch Andrea D, Pillai Anjana, Hoteit Maarouf, Volk Michael, Odewole Mobolaji, Scaglione Steven, Guy Jennifer, Said Adnan, Feld Jordan J, John Binu V, Frenette Catherine, Mantry Parvez, Rangnekar Amol S, Oloruntoba Omobonike, Leise Michael, Jou Janice H, Bhamidimarri Kalyan Ram, Kulik Laura, Ioannou George N, Huang Annsa, Tran Tram, Samant Hrishikesh, Dhanasekaran Renumathy, Duarte-Rojo Andres, Salgia Reena, Eswaran Sheila, Jalal Prasun, Flores Avegail, Satapathy Sanjaya K, Kagan Sofia, Gopal Purva, Wong Robert, Parikh Neehar D, Murphy Caitlin C
Аннотация
METHODS: We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting.
RESULTS: Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18-0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55-2.33).
CONCLUSIONS: In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.