03:36 PM Abstract No. 320 Survival analysis of patients with hepatitis c and hepatocellular carcinoma receiving interventional oncology therapies and direct-acting antivirals with 12-week sustained viral response

Abstract

To investigate the impact of direct-acting antivirals (DAA) and 12-week sustained viral response (SVR12) in patients with hepatocellular carcinoma (HCC) and hepatitis C (HCV) viral infections treated by interventional oncology (IO) therapies. Retrospective analysis of HCC patients diagnosed from 2005 to 2016 at a single institution with HCC treated by IO. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to assess survival. 478 patients met inclusion criteria (mean age 63.7±9.5 yrs, 79% male). IO treatments include catheter-directed therapies (CDT) (n=252, 53%), ablation (n=123, 26%) and combination locoregional therapy (Combo LRT) (n=103, 22%). Of the HCC patients treated by IO, 292 (59%), 95 (33%) and 64 (67%) IO patients had HCV, received DAA and achieved SVR12 respectively. Of the patients receiving DAA therapy, 19 (21%) had HCC occurrence and 34 (49%) had recurrence following completion of DAA therapy. Median overall survival (OS) of the cohort was 26.7 mo (95% CI: 21.9-29.9 mo). OS for CDT, ablation and Combo LRT was 19.7 mo (CI: 16.5-22.8), 37.3 mo (CI: 30.7-49.9) and 29.3 mo (CI: 24.2-38.0) respectively (p<0.0001). OS in IO patients with HCV was 30.7 mo (CI: 24.2-35.2) vs 22.2 mo in non-HCV patients (CI: 17.8-27.8, p=0.03). IO patients with HCV who received DAA had higher survival (49.2 mo, CI: 36.5-not reached) vs those that did not receive DAA (18.5 mo, CI: 14.1-25.3, p<0.0001). In IO patients with HCV and SVR12 after DAA, OS was 71.8 mo (CI: 42.3-not reached) vs 26.7 mo (CI: 15.9-31.1) in the non-SVR12 group (p<0.0001). Multivariable analysis (MVA) revealed AJCC, Child-Pugh Score and tumor size to be independent factors for OS in the entire cohort (p<0.05). Within the HCV subgroup, significant factors were receiving ablation vs CDT and receiving DAA therapy (p<0.05). Significant factors in patients receiving both DAA and IO therapies were MELD score and SVR12 status (p<0.05). DAA therapy and achieving SVR12 is associated with higher OS in patients with HCV and HCC treated with Interventional Oncology therapies. This analysis supports the importance of treating HCV to SVR12 as part of HCC management.