Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis
2 UNIPA - Università degli studi di Palermo - University of Palermo
3 U1162 - Génomique Fonctionnelle des Tumeurs Solides
4 Hôpital Jean Verdier [AP-HP]
5 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
6 UTokyo - The University of Tokyo
7 UNIMI - Università degli Studi di Milano = University of Milan
8 Ogaki Hospital
9 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna [Bologne]
10 National Kaohsiung University of Science and Technology [Taiwan]
11 MESuRS - Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires
12 PACRI - Pasteur-Cnam Risques infectieux et émergents
13 Helwan University
14 Cairo University
15 Niguarda Hospital [Milan, Italy]
16 TMDU - Tokyo Medical and Dental University [Japan]
17 University of Texas Southwestern Medical Center
18 National Liver Institute [Menoufia, Egypt]
19 PoliclinicoTor Vergata - Fondatione PTV
20 Inselspital - Bern University Hospital [Berne]
21 Valme University Hospital
22 Unipd - Università degli Studi di Padova = University of Padua
23 ANRS France Recherche Nord & sud Sida-hiv hépatites
24 UC / UniCan - Universidad de Cantabria [Santander] = University of Cantabria [Spain] = Université de Cantabrie [Espagne]
25 CIBERehd - Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas = Biomedical Research Network Center for Liver and Digestive Diseases [Madrid]
26 Unifg - Università degli Studi di Foggia = University of Foggia
27 UHasselt - Hasselt University
- Fonction : Auteur
- PersonId : 801099
- ORCID : 0000-0003-2489-0768
- IdRef : 074345273
- Fonction : Auteur
- PersonId : 173689
- IdHAL : kevin-jean
- ORCID : 0000-0001-6462-7185
- IdRef : 17816903X
- Fonction : Auteur
- PersonId : 801980
- ORCID : 0000-0002-8062-1346
- Fonction : Auteur
- PersonId : 755799
- ORCID : 0000-0001-9772-9591
- Fonction : Auteur
- PersonId : 806664
- ORCID : 0000-0002-6734-7178
Résumé
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, I2=74.6%) and 5.7 (2.5 to 15.3, I2=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.