Changes in clinical outcomes in Japanese patients with hepatocellular carcinoma due to hepatitis C virus following the development of direct-acting antiviral agents.

Abstract

Direct-acting antivirals (DAAs) have been accessible in Japan since 2014. The aim of this study is to compare how the prognosis of patients with hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCV-HCC) changed before and after DAA development. A retrospective analysis of 1949 Japanese HCV-HCC patients from January 2000 to January 2023 categorized them into pre-DAA (before 2013, n=1169) and post-DAA (after 2014, n=780) groups. Changes in clinical features and prognosis were assessed. Despite no significant differences in BCLC stage between groups, the post-DAA group exhibited higher rates of sustained virological response (SVR) (45.6% vs. 9.8%), older age (73 vs 69years), lower levels of AST (40 vs 56IU/L), ALT (31 vs 46IU/L), and AFP (11.7 vs 23.6ng/mL), higher platelet count (13.5 vs 10.8×104/μL), better prothrombin time (88.0% vs 81.9%), and better ALBI score (-2.54 vs -2.36) (all P<0.001). The post-DAA group also showed higher rates of curative treatments (74.1% vs 65.2%) and significantly improved recurrence-free survival (median 2.8 vs 2.1years). Adjusted for inverse probability weighting, overall survival was superior in the post-DAA group (median 7.4 vs 5.6years, P<0.001). Subanalysis within the post-DAA group revealed significantly shorter overall survival for patients without SVR (median 4.8years vs NA vs NA) compared to pre-SVR or post-SVR patients (both P<0.001). No significant difference in OS was observed between the pre-SVR and post-SVR groups (P=1.0). The development of DAA therapy has dramatically improved the prognosis of HCV-HCC patients.