Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study

Lee, Shou-Wu; Yang, Sheng-Shun; Tsai, Pei-Chien; Huang, Chung-Feng; Chen, Chi-Yi; Hung, Chao-Hung; Chen, Chien-Hung; Tai, Chi-Ming; Cheng, Pin-Nan; Kuo, Hsing-Tao; Tseng, Kuo-Chih; Mo, Lein-Ray; Lo, Ching-Chu; Huang, Yi-Hsiang; Lin, Han-Chieh; Lee, Pei-Lun; Bair, Ming-Jong; Chang, Te-Sheng; Lin, Chun-Yen; Wang, Szu-Jen; Hsieh, Tsai-Yuan; Yang, Tzeng-Hue; Peng, Cheng-Yuan; Yang, Chi-Chieh; Chong, Lee-Won; Huang, Chien-Wei; Lin, Chih-Wen; Chu, Cheng-Hsin; Tsai, Ming-Chang; Kao, Jia-Horng; Liu, Chun-Jen; Chuang, Wan-Long; Lee, Teng-Yu; Yu, Ming- Lung; ,

doi:.0..

Original Article

Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study

Shou-Wu Lee^1,2,3, Sheng-Shun Yang^1,3,4, Pei-Chien Tsai⁵, Chung-Feng Huang⁵, Chi-Yi Chen⁶, Chao-Hung Hung⁷, Chien-Hung Chen⁷, Chi-Ming Tai^8,9, Pin-Nan Cheng¹⁰, Hsing-Tao Kuo¹¹, Kuo-Chih Tseng¹², Lein-Ray Mo¹³, Ching-Chu Lo¹⁴, Yi-Hsiang Huang^15,16, Han-Chieh Lin¹⁷, Pei-Lun Lee¹⁸, Ming-Jong Bair^19,20, Te-Sheng Chang^21,22, Chun-Yen Lin²³, Szu-Jen Wang²⁴, Tsai-Yuan Hsieh²⁵, Tzeng-Hue Yang²⁶, Cheng-Yuan Peng²⁷, Chi-Chieh Yang²⁸, Lee-Won Chong²⁹, Chien-Wei Huang³⁰, Chih-Wen Lin³¹, Cheng-Hsin Chu³², Ming-Chang Tsai^2,33, Jia-Horng Kao³⁴, Chun-Jen Liu³⁴, Wan-Long Chuang⁵, Teng-Yu Lee^1,2, Ming- Lung Yu^5,35, on behalf of TACR investigators

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
²School of Medicine, Chung Shan Medical University, Taichung, Taiwan
³Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung, Taiwan
⁴Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
⁵Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
⁶Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
⁷Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
⁸Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
⁹School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
¹⁰Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
¹¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan, Taiwan
¹²Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; School of Medicine, Tzu Chi University, Hualien, Taiwan
¹³Tainan Municipal Hospital, Tainan, Taiwan
¹⁴Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan
¹⁵Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
¹⁶Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
¹⁷Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
¹⁸Liouying Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
¹⁹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
²⁰Mackay Medical College, New Taipei, Taiwan
²¹Division of Hepatogastroenterology, Department of Internal Medicine, ChiaYi Chang Gung Memorial Hospital, Chiayi, Taiwan
²²College of Medicine, Chang Gung University, Taoyuan, Taiwan
²³Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
²⁴Division of Gastroenterology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan
²⁵Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
²⁶Lotung Pohai Hospital, Lo-Hsu Medical Foundation, Yilan, Taiwan
²⁷School of Medicine, China Medical University; Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
²⁸Department of gastroenterology, Division of internal medicine, Show Chwan Memorial Hospital, Taiwan
²⁹Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
³⁰Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
³¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, and School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
³²Division of gastroenterology and hepatology, Internal medicine, MacKay Memorial Hospital , Taipei, Taiwan
³³Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
³⁴Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
³⁵Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan

Correspondence :

Teng-Yu Lee ,
Email: tylee@vghtc.gov.tw
Ming- Lung Yu ,
Email: fish6069@gmail.com

Received: November 10, 2024 Revised: January 2, 2025 Accepted: January 16, 2025

ABSTRACT

Background & Aims
The survival benefit of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC), particularly in BCLC stages B/C, remains largely uncertain. We aimed to explore the impact of DAA therapy on overall survival (OS) in HCC patients using a nationwide cohort study.
Methods
We utilized the nationwide Taiwan Association for the Study of the Liver (TASL) HCV Registry (TACR) database to include all adults receiving a DAA therapy for HCV, excluding those with other viral infections, liver transplantation, non-HCC malignancies, and terminal-staged HCC. We respectively analyzed the adjusted odds ratio (aOR) for SVR and adjusted hazard ratio (aHR) for OS.
Results
Between December 2013 and December 2020, 2,205 (9.3%) patients with HCC and 21,569 (90.7%) patients without HCC were recruited. The sustained virological response (SVR) rates were 96.6% in the HCC group and 98.8% in the non-HCC group (p < 0.001), with HCC being an independent risk factor affecting SVR (aOR 0.41, 95% CI 0.31-0.54; p < 0.001). In the whole patient cohort, SVR was independently associated with improved OS (aHR 0.46, 95% CI 0.35-0.60; p < 0.001). Among patients with baseline HCC, SVR remained an independent factor related to OS (aHR 0.41, 95% CI 0.28-0.59; p < 0.001). The impact of SVR on OS persisted significantly across BCLC stages 0-A and stages B-C.
Conclusions
High SVR rates among HCC patients underscore the importance of DAA therapy in enhancing OS, reaffirming its efficacy across various HCC stages.

KeyWords: chronic hepatitis C; antivirals; sustained virological response; liver cancer; survival