Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study

Amit G Singal; Nicole E Rich; Neil Mehta; Andrea Branch; Anjana Pillai; Maarouf Hoteit; Michael Volk; Mobolaji Odewole; Steven Scaglione; Jennifer Guy; Adnan Said; Jordan J Feld; Binu V John; Catherine Frenette; Parvez Mantry; Amol S Rangnekar; Omobonike Oloruntoba; Michael Leise; Janice H Jou; Kalyan Ram Bhamidimarri; Laura Kulik; Tram Tran; Hrishikesh Samant; Renumathy Dhanasekaran; Andres Duarte-Rojo; Reena Salgia; Sheila Eswaran; Prasun Jalal; Avegail Flores; Sanjaya K Satapathy; Robert Wong; Annsa Huang; Suresh Misra; Myron Schwartz; Robert Mitrani; Sasank Nakka; Wassim Noureddine; Chanda Ho; Venkata R Konjeti; Alexander Dao; Kevin Nelson; Kelly Delarosa; Usman Rahim; Meher Mavuram; Jesse J Xie; Caitlin C Murphy; Neehar D Parikh

doi:10.1053/j.gastro.2019.01.027

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Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study

Journal article

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Peer reviewed

Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study

Amit G Singal, Nicole E Rich, Neil Mehta, Andrea Branch, Anjana Pillai, Maarouf Hoteit, Michael Volk, Mobolaji Odewole, Steven Scaglione, Jennifer Guy, …

Gastroenterology (New York, N.Y. 1943), Vol.156(6), pp.1683-1692.e1

2019-05

DOI: https://doi.org/10.1053/j.gastro.2019.01.027

PMCID: PMC6598433

PMID: 30660729

Abstract

Recurrence

Liver Cancer

Direct-Acting Antiviral

Hepatitis C Virus

There is controversy over the effects of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection on hepatocellular carcinoma (HCC) recurrence and tumor aggressiveness. We compared HCC recurrence patterns between DAA-treated and untreated HCV-infected patients who had achieved a complete response to HCC treatment in a North American cohort. We conducted a retrospective cohort study of patients with HCV-related HCC with a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy from January 2013 through December 2017 at 31 health systems throughout the United States and Canada. Cox regression was used to examine the association between DAA therapy and time to recurrence after a complete response, with DAA therapy analyzed as a time-varying exposure. We also estimated the association between DAA therapy and risk of early HCC recurrence (defined as 365 days after complete response). Of 793 patients with HCV-associated HCC, 304 (38.3%) received DAA therapy and 489 (61.7%) were untreated. HCC recurred in 128 DAA-treated patients (42.1%; early recurrence in 52 patients) and 288 untreated patients (58.9%; early recurrence in 227 patients). DAA therapy was not associated with HCC recurrence (hazard ratio 0.90, 95% confidence interval 0.70–1.16) or early HCC recurrence (hazard ratio 0.96, 95% confidence interval 0.70–1.34) after we adjusted for study site, age, sex, Child-Pugh score, α-fetoprotein level, tumor burden, and HCC treatment modality. In DAA-treated and untreated patients, most recurrences were within the Milan criteria (74.2% vs 78.8%; P = .23). A larger proportion of DAA-treated than untreated patients received potentially curative HCC therapy for recurrent HCC (32.0% vs 24.6%) and achieved a complete or partial response (45.3% vs 41.0%) but this did not achieve statistical significance. In a large cohort of North American patients with complete response to HCC treatment, DAA therapy was not associated with increased overall or early HCC recurrence. HCC recurrence patterns, including treatment response, were similar in DAA-treated and untreated patients. [Display omitted]

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.125 Hepatitis; 1.125.83 HCV
Web Of Science research areas: Gastroenterology & Hepatology
ESI research areas: Clinical Medicine

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Title: Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study
Creators: Amit G Singal - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Nicole E Rich - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Neil Mehta - Division of Gastroenterology, University of California San Francisco, San Francisco, California
Andrea Branch - Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Anjana Pillai - Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
Maarouf Hoteit - Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
Michael Volk - Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
Mobolaji Odewole - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Steven Scaglione - Division of Hepatology, Loyola University Medical Center, Chicago, Illinois
Jennifer Guy - Department of Transplantation, California Pacific Medical Center, San Francisco, California
Adnan Said - Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin
Jordan J Feld - Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
Binu V John - Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
Catherine Frenette - Division of Organ Transplantation, Scripps Green Hospital, San Diego, California
Parvez Mantry - Liver Institute at Methodist Dallas, Dallas, Texas
Amol S Rangnekar - Division of Gastroenterology, Georgetown University Hospital, Washington, DC
Omobonike Oloruntoba - Division of Gastroenterology and Hepatology, Duke University Health Center, Durham, North Carolina
Michael Leise - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Janice H Jou - Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
Kalyan Ram Bhamidimarri - Division of Hepatology, University of Miami Miller School or Medicine, Miami, Florida
Laura Kulik - Division of Hepatology, Northwestern University, Chicago, Illinois
Tram Tran - Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
Hrishikesh Samant - Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
Renumathy Dhanasekaran - Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
Andres Duarte-Rojo - Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Reena Salgia - Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
Sheila Eswaran - Division of Gastroenterology, Rush Medical College, Chicago, Illinois
Prasun Jalal - Division of Abdominal Transplantation, Baylor College of Medicine, Dallas, Texas
Avegail Flores - Division of Gastroenterology, Washington University School of Medicine, Louis, Missouri
Sanjaya K Satapathy - Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
Robert Wong - Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California
Annsa Huang - Division of Gastroenterology, University of California San Francisco, San Francisco, California
Suresh Misra - Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Myron Schwartz - Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Robert Mitrani - Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
Sasank Nakka - Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
Wassim Noureddine - Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
Chanda Ho - Department of Transplantation, California Pacific Medical Center, San Francisco, California
Venkata R Konjeti - Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
Alexander Dao - Division of Gastroenterology, Georgetown University Hospital, Washington, DC
Kevin Nelson - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
Kelly Delarosa - Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
Usman Rahim - Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
Meher Mavuram - Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
Jesse J Xie - Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Caitlin C Murphy - Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
Neehar D Parikh - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
Publication Details: Gastroenterology (New York, N.Y. 1943), Vol.156(6), pp.1683-1692.e1
Publisher: Elsevier Inc
Grant note: R01 CA222900 / National Cancer Institute (https://doi.org/10.13039/100000054)
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hepatology
Language: English
Resource Type: Journal article
PMID: 30660729
PMCID: PMC6598433
Record Identifier: 991031575446102976