Setting the Record Straight: Utility and Outcomes in Patients With HCV Related HCC.

Area of Science:

• Hepatology
• Virology
• Oncology

Background:

• Direct-acting antiviral (DAA) therapy effectiveness in patients with active hepatocellular carcinoma (HCC) remains unclear.
• National Health Service (NHS) England now approves DAA therapy for all viremic patients, including those with HCC.

Purpose of the Study:

• To evaluate real-world treatment outcomes of DAA therapy in patients with HCV-related HCC.
• To compare the HCV care cascade and sustained virologic response (SVR) rates between patients with HCC and those with advanced fibrosis/cirrhosis without HCC.

Main Methods:

• Retrospective study using the National Hepatitis C registry in South-East England (2016-2023).
• Included 1518 HCV RNA-positive patients receiving DAA therapy, comprising an HCC cohort (7.6%) and a non-HCC cohort (92.4%).
• Assessed primary outcomes including SVR rates and overall survival (OS) based on Barcelona Clinic Liver Cancer (BCLC) staging.

Main Results:

• SVR rates were 87% in the HCC cohort versus 94.5% in the non-HCC cohort (p=0.003).
• Multivariate analysis identified HCC presence as an independent factor associated with lower SVR probability (OR 0.4; p=0.029).
• Median OS varied significantly by BCLC stage (80 months for BCLC 0-A to 3 months for BCLC D), with longer OS observed in patients achieving SVR.

Conclusions:

• High uptake and completion rates of DAA therapy in HCV-related HCC patients lead to acceptable cure rates.
• DAA therapy is an appropriate clinical standard for HCV/HCC patients to improve outcomes, but should be avoided in those with very short life expectancy.
• Treatment outcomes and survival are significantly influenced by HCC stage and SVR achievement.