Recurrence of Hepatocellular Carcinoma Following Eradication of Hepatitis C Infection

Abstract

Introduction: With the widespread use of novel, well-tolerated, and effective therapeutic modalities for the treatment of Hepatitis C (HCV), concern has been raised regarding the recurrence of hepatocellular carcinoma (HCC) after completion of antiviral therapy. In our experience treating HCV infected patients with direct-acting antivirals (DAA), among some of those with a history of HCC, we observed a relapse of the malignancy after DAA therapy. However, there is no substantial data available on the rate of recurrence amongst this population of patients. We aim to compare demographic and clinical characteristics of HCC patients treated for HCV who subsequently developed recurrence of HCC as compared to those who remain in clinical remission.Table 1: Clinical characteristics between those patients with recurrence and non recurrenceTable 2: Treatment modalities used for treatment of HCC in both groups.Methods: We conducted a retrospective analysis on a cohort of patients treated with DAAs within our hospital network. Those with active hepatitis C as well as hepatocellular carcinoma who remained without evidence of active malignancy for approximately one year were included in the study. Those who had evidence of relapse of HCC after therapy were compared to those who remained disease free. We used descriptive statistics to compare the two groups. Continuous variables were analyzed using measures of central tendencies and dispersion. We used frequency of distributions to interpret categorical variables. Results: Of the 10 HCC patients treated for HCV who were in remission prior to initiation of therapy, four patients were found to have recurrence and six patients did not have recurrence of their HCC. Those with recurrence tended to be younger with a higher post treatment AFP level. Patients were treated with either ledipasvir+sofosbuvir, ledipasvir+sofosbuvir+ribavirin or sofosbuvir+simeprevir+ribavirin. One patient was treated for eight weeks, eight patients were treated for 12 weeks and one patient was treated for 24 weeks. 75% had Barcelona stage A disease at relapse. Recurrence of HCC occurred as early as 41 days after completion of therapy (range 41-186 days). Conclusion: Our preliminary results suggest a 40% recurrence rate of HCC amongst those treated with DAA therapy, with relapse occurring as early as 41 days after eradication of the virus. HCC relapse was associated with higher AFP levels and younger age. However, additional studies are needed to confirm our findings and to further characterize the implication of eradication of hepatitis C in HCC and the underlying pathogenic mechanisms involved.