HCV Eradication in Primary or Secondary Prevention Optimizes Hepatocellular Carcinoma Curative Management

Abstract

To assess the impact of HCV eradication on the outcomes of cirrhotic patients treated curatively for incidental hepatocellular carcinoma (HCC) detected during surveillance program. Data were collected on 1323 French patients with compensated biopsy-proven HCV cirrhosis recruited in 35 centers (ANRS CO12 CirVir cohort). Sustained virological responses (SVR) and the occurrence of HCC were recorded prospectively. During a median follow-up (FU) of 68.3 months, 218 patients developed HCC, 126 of whom underwent a curative procedure as first-line therapy (ablation=95, resection=31). The HCC BCLC stage was 0/A in 97.5% of patients; 74 (58.7%) never achieved SVR. During a median FU of 26.0 months after HCC treatment, 59 (46.8%) experienced HCC recurrence. SVR was not associated with a recurrence, whether considering final SVR status (HR=0.77 [0.43; 1.39]; P=0.39) or its time to achievement (prior to/after HCC occurrence; global P=0.28). During the same timeframe, 46 HCC patients (36.5%) died (liver failure: 41.9%, HCC progression: 37.2%, extrahepatic causes: 20.9%). Under multivariate analysis, SVR was associated with improved survival (HR=0.21 [0.08; 0.52]; P=0.001). Survival benefit was explained by a lower incidence of liver decompensation and higher rates of sequential HCC re-treatment. Direct antivirals intake was not associated with a higher risk of HCC recurrence but with improved survival (HR=0.23 [0.06; 0.83]; P=0.024). HCV eradication in primary or secondary prevention optimizes HCC management through preservation of liver function and improves survival, whatever the regimen.