Curative treatment is feasible for recurrent hepatocellular carcinoma regardless of recurrence pattern after hepatitis C virus eradication with interferon-free direct-acting antiviral therapy.

BACKGROUND

Interferon (IFN)-free direct-acting antivirals (DAAs) have significantly improved hepatitis C virus (HCV) elimination rates. However, new-onset or recurrence of hepatocellular carcinoma (HCC) remains common even after achieving sustained virological response (SVR). This study investigated the clinical significance and treatability of HCC recurrence patterns after SVR, which have not been fully explored yet.

METHODS

We retrospectively analyzed the risk factors for HCC development in 279 patients with HCV-associated chronic liver disease who achieved SVR with DAA therapy after July 2014. Twenty-eight patients with HCC recurrence after SVR were classified by the type of recurrence (intrahepatic metastasis, hypervascularization, and de novo). Correlation between tumor markers (alpha-fetoprotein and des-γ-carboxy prothrombin) at the time of previous HCC and at the time of recurrence was examined.

RESULTS

Thirty-three patients (11.8%) developed HCC after SVR. Multivariate analysis revealed that a history of HCC was the only independent risk factor for HCC development after SVR (hazard ratio 14.4, P < 0.001). Among the 28 patients with HCC recurrence, intrahepatic metastasis was observed in eight (29%), hypervascularization in seven (25%), and de novo recurrence in six (21%) patients. At the time of recurrence, 27 patients (96%) had Barcelona clinic liver cancer stage 0/A disease. Curative treatment was possible in 27 patients (96%).

CONCLUSIONS

HCC recurrence after SVR was detected early, regardless of the recurrence pattern, allowing for the selection of curative treatment. In the DAA era, HCC recurrence after SVR in patients with a history of HCC could be appropriately managed through strict follow-up.