The Kirby Institute, UNSW Sydney, Sydney, Australia. Electronic address: firstname.lastname@example.org.
The Kirby Institute, UNSW Sydney, Sydney, Australia.
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
St Vincent's Clinical School, UNSW Sydney, Australia.
Storr Liver Centre, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Sydney, Australia.
Risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) HCV therapy remains unclear. The aims of this study were: 1) In patients with HCV-related cirrhosis, to compare the rate of HCC occurrence following DAA versus interferon (IFN)-based cure, and; 2) In patients who received curative HCC treatment, to compare rate of HCC recurrence following DAA versus IFN-based cure.
A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person years (py) among patients with a sustained virological response (SVR).
A total of 41 studies (n=13,875 patients), including 26 on HCC occurrence (IFN=17, DAA=9; prospective=19, retrospective=5, retrospective-prospective=2), and 17 on HCC recurrence (IFN=7, DAA=10; prospective=11, retrospective=5 and retrospective-prospective=1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 versus 5.5 years), and average age older (60 versus 52 years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 versus 5.0 years), but average age similar (64 versus 66 years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86, 1.52) and 2.96/100 py (95% CI 1.76, 4.96) in IFN and DAA studies. HCC recurrence was 9.21/100 py (95% CI 7.18, 11.81) and 12.16/100 py (95% CI 5.00, 29.58) in IFN and DAA studies. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68, 95% CI 0.18, 2.55, P=0.55) or recurrence (RR 0.62, 95% CI 0.11, 3.45, P=0.56).
There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy.