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

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.