Hepatocellular Carcinoma in Hepatitis C Virus Patients after Treatment by Directly Acting Antiviral Drugs Compared to Hepatitis C Virus Non Treated Patients

Abstract

Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers globally. It is considered as leading cause of cancer related death that occurs mostly in patients with underlying significant liver fibrosis and cirrhosis. Objective to compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs. Patients and Methods The study was conducted on patients with de novo HCC presented at HCC Clinic and Tropical medicine department at Ain Shams University Hospitals from January 2019 to January 2020. Total number of HCC cases visited the HCC clinic was 382 patients. 196 patients with de novo HCC were enrolled in the study according to inclusion criteria and divided into two groups: Group (A): included 79 patients with de novo HCC that received DAAs according to NCCVH. 64 males (81%), 15 females (19%) with mean age of 60 years. Group (B): included 117 patients with de novo HCC that didn’t receive DAAs treatment before; 82 males (70.1%) 35 females (29.9%) with a mean age of 61.9 years. Results In the current study we found there was no difference in tumor aggressiveness between patients with de novo HCC following DAA and patients with HCC that didn’t receive DAA regarding different scoring system except for Child pugh score was significantly higher in group (A), and for BCLC staging was significantly more advanced in group(A). The Current study revealed 69 patients (87.3%) of Group (A) achieved SVR with DAAs. with no significant statistical value between different regimens of DAAs regarding relapsing rate or behavior of HCC. Conclusion Despite the great advance in HCV treatment in the era of DAA drugs, HCC remains to be a great risk for cirrhotic patients. Moreover, patients with a history of HCC have to be closely monitored before and after treatment with DAA. There were no difference between studied group regarding tumor size, tumor number, tumor site, tumor extension, tumor metastasis, vascular invasion or AFP. but lymph node invasion was more significant in group (A). There were no difference between studied group regarding Child grade, FIB-4 score or PST. Patients of group (A) showed more advanced liver disease regarding BCLC stage than those of group (B).