Sustained virological response improved survival outcomes after curative resection in patients with hepatitis C virus-related hepatocellular carcinoma in the era of direct‑acting antiviral therapy.

BACKGROUND AND AIM: The impact of sustained virological response (SVR) on outcomes of patients with hepatocellular carcinoma (HCC) undergoing liver resection (LR) was assessed.

METHODS

This retrospective cohort study included 344 patients with hepatitis C virus (HCV)-related HCC who underwent LR. Patients were divided into three groups: preoperatively achieving SVR (pre-SVR); postoperatively achieving SVR (post-SVR); and not achieving SVR (non-SVR).

RESULTS

145 patients received direct-acting antivirals, 76 received interferon-based therapy, and 123 were untreated. 95 patients were pre-SVR, 87 were post-SVR, and 162 were non-SVR, including untreated patients. Five-year overall survival was 83% in the pre-SVR group, 92% in the post-SVR group, and 50% in the non-SVR group (p < 0.001). Pre-SVR (adjusted HR (aHR) 0.35; 95% CI 0.19-0.62; p < 0.001) and post-SVR (aHR 0.18; 95% CI 0.09-0.36; p < 0.001) were independent predictors of mortality. Five-year recurrence-free survival was 75% in the pre-SVR group, 55% in the post-SVR group, and 45% in the non-SVR group (p < 0.001). Pre-SVR (aHR 0.45; 95% CI 0.28-0.73; p = 0.001) was an independent predictor of recurrence, whereas post-SVR (aHR 0.84; 95% CI 0.57-1.24; p = 0.37) was not.

CONCLUSIONS

Achieving SVR before or after LR decreased the mortality risk and achieving SVR before LR decreased the recurrence risk of patients with HCV-related HCC undergoing LR.