Impact of sustained virological response on prognosis after hepatectomy for hepatitis C-related hepatocellular carcinoma: a retrospective cohort study.

BACKGROUND

Eradicating hepatitis C virus (HCV) with direct-acting antivirals (DAAs) reduces hepatocellular carcinoma (HCC) risk, but its impact on post-hepatectomy outcomes remains uncertain. We evaluated whether achieving sustained virological response (SVR) improves prognosis in HCV-related HCC after curative hepatectomy.

METHODS

This retrospective cohort study included HCV-related HCC patients undergoing hepatectomy (2017-2024). Patients were stratified by SVR status: DAA-treated Group (achieved SVR post-DAA) and Untreated Group (no treatment). Kaplan-Meier analysis compared recurrence-free survival (RFS) and overall survival (OS); Cox regression identified prognostic factors.

RESULTS

Among 75 patients undergoing curative hepatectomy, the DAA-treated Group demonstrated significantly superior 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates compared to the Untreated Group (p < 0.01). Multivariate analysis indicated that SVR was significantly associated with improved outcomes for both endpoints (p < 0.01). Exploratory stratified analysis indicated that while SVR conferred a robust survival benefit in HBV-negative patients (p < 0.01), this advantage did not reach statistical significance in the HBV-coinfected subgroup. Notably, the prognostic value of SVR was rigorously validated through propensity score matching (n = 52) and a 3-month landmark analysis designed to mitigate immortal time bias; both sensitivity analyses consistently confirmed that SVR was associated with significant improvements in OS and RFS (p < 0.05).

CONCLUSION

Successful eradication of HCV via DAA therapy significantly enhances post-hepatectomy survival and mitigates recurrence risks.