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Title: | Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis | Authors: | Sapena, Victor Enea, Marco Torres , Ferran Celsa, Ciro Rios, Jose Rizzo, Giacomo Emanuele Maria Nahon, Pierre Marino, Zoe Tateishi, Ryosuke Minami, Tatsuya Sangiovanni, Angelo Forns, Xavier Toyoda, Hidenori Brillanti, Stefano Conti, Fabio Degasperi, Elisabetta Yu, Ming-Lung Tsai, Pei-Chien Jean, Kevin El Kassas, Mohamed Shousha, Hend Ibrahim Omar, Ashraf Zavaglia, Claudio Nagata, Hiroko Nakagawa, Mina Asahina, Yasuhiro Singal, Amit G. Murphy, Caitlin Kohla, Mohamed Masetti, Chiara Dufour, Jean-Francois Merchante, Nicolas Cavalletto, Luisa Chemello, Liliana L. C. Pol, Stanislas Crespo, Javier Calleja, Jose Luis Villani, Rosanna Serviddio, Gaetano Zanetto, Alberto Shalaby, Sarah Russo, Francesco Paolo BIELEN, Rob Trevisani, Franco Camma, Calogero Bruix, Jordi Cabibbo, Giuseppe Reig, Maria |
Issue Date: | 2022 | Publisher: | BMJ PUBLISHING GROUP | Source: | Gut, 71 (3) , p. 593-604 | Abstract: | Objective The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. Design We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. Results Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I-2=74.6%) and 5.7 (2.5 to 15.3, I-2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). Conclusion Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified. | Notes: | Reig, M (corresponding author), Univ Barcelona, IDIBAPS, Hosp Clin Barcelona,CIBEREHD, Barcelona Clin Liver Canc BCLC Grp,Liver Unit, Barcelona, Catalunya, Spain.; Cabibbo, G (corresponding author), Univ Palermo, PROMISE, Sect Gastroenterol & Hepatol,Internal Med & Med S, Dept Hlth Promot Mother & Child Care, Palermo, Italy. giuseppe.cabibbo78@gmail.com; MREIG1@clinic.cat |
Keywords: | hepatocellular carcinoma;antiviral therapy;meta-analysis | Document URI: | http://hdl.handle.net/1942/36479 | ISSN: | 0017-5749 | e-ISSN: | 1468-3288 | DOI: | 10.1136/gutjnl-2020-323663 | ISI #: | 000728860500001 | Rights: | Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
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Hepatocellular_carcinoma_recur.pdf Restricted Access | Published version | 2.04 MB | Adobe PDF | View/Open Request a copy |
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