Efficacy and Long-Term Outcomes of Direct-Acting Antivirals in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

BACKGROUND/AIMS: The role of direct-acting antivirals (DAAs) in patients with hepatocellular carcinoma (HCC) remains uncertain due to conflicting data on virologic efficacy and long-term outcomes.

METHODS

This meta-analysis investigated studies reporting the sustained virologic response (SVR), recurrence, and overall survival in patients with HCC treated with DAAs.

RESULTS

Eighty-eight studies were included, comprising 8,839 patients with HCC who were treated with DAAs. The pooled SVR rate in patients with HCC was 89% (95% confidence interval [CI], 87% to 91%). However, the SVR varied significantly depending on tumor viability; patients with non-viable HCC had the highest SVR (91%), followed by those with mixed (88%) and viable HCC (84%). The SVR was significantly lower in the HCC group than in the non-HCC group (risk ratio [RR], 0.95; 95% CI, 0.92 to 0.98). In 28 studies reporting on recurrence outcomes, patients with HCC who were treated with DAAs had a 40% lower recurrence risk than non-DAA-treated patients (RR, 0.60; 95% CI, 0.49 to 0.75). Pooled analyses of adjusted estimates showed that DAA treatment was independently associated with reduced recurrence (hazard ratio [HR], 0.47; 95% CI, 0.32 to 0.70) and all-cause mortality (HR, 0.40; 95% CI, 0.31 to 0.51). An SVR was linked to an improved prognosis, with lower recurrence (HR, 0.43; 95% CI, 0.31 to 0.61) and mortality (HR, 0.41; 95% CI, 0.14 to 1.24) risks.

CONCLUSIONS

DAAs are effective in patients with HCC. Despite slightly lower SVR rates than in patients without HCC, the overall benefits support the use of antiviral therapy in patients with HCC.