Antiviral therapies are associated with reduced mortality but under-utilized in patients with viral hepatocellular carcinoma: a multinational REAL-HCC study

Antiviral treatment can reduce mortality of viral hepatocellular carcinoma (HCC), but may be underutilized.

In a multinational real-world consortium of HCC patients with hepatitis B (HBV-HCC) or C (HCV-HCC), we assessed nucleos(t)ide analog treatment rate in HBV-HCC (2007-2023) and direct acting antiviral treatment rate in HCV-HCC (2015-2023).

Among 3973 HCC patients (3186 HBV, 647 HCV, 140 HBV/HCV), 49.7% of HBV-HCC and 63.2% of HCV-HCC received antiviral treatment. For HBV, lower treatment rates were observed in female (41.7% vs. 51.8%), older (> 60) (45.3% vs. 54.5%), non-cirrhosis and decompensated cirrhosis (vs. compensates cirrhosis: 41.3% vs. 43.2% vs. 76.7%), and Asia region (37.9% vs. 85.0%) patients; for HCV, lower rates in male (59.0% vs. 72.4%), compensated and decompensated cirrhosis (vs. noncirrhosis: 62.9% vs. 54.0% vs. 73.2%), and non-Asia region (58.2% vs. 69.9%) patients. Child A cirrhosis and Barcelona Clinic Liver Cancer (BCLC) 0/A patients had highest treatment rates followed by Child B and C or BCLC B, C, or D for both HBV (78.6%, 48.3%, 43.8%; 59.9%, 50.9%, 36.7%, 41.0%) and HCV (68.2%, 53.3%, 38.6%; 72.5%, 53.3%, 51.9%, 30.2%), all P<0.001. Factors independently associated with lower treatment rates were: female, age>60, Asia region, noncirrhosis, and BCLC B or C (vs. 0/A) for HBV; male, age>65, Child B or C cirrhosis (vs. noncirrhosis), and BCLC B or C for HCV. Antiviral treatment was independently associated with reduced mortality in both HBV-HCC and HCV-HCC patients.

Despite survival benefits, antiviral therapies were substantially underutilized in both HBV-HCC and HCV-HCC, particularly advanced patients.