Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed After HCV SVR

Abstract

Background and Aim: The clinical presentation and survival of hepatocellular carcinoma (HCC) developed after hepatitis C virus (HCV) eradication as compared to HCC developed in viremic patients are not well characterized. We aimed to investigate the characteristics and survival between HCV patients with and without HCV viremia at HCC diagnosis. Methods: We retrospectively analyzed and examined overall survival outcomes in 1389 HCV-related HCC patients, including 301 with HCC developed after HCV eradication (post-SVR HCC) and 1088 with HCV viremia at HCC diagnosis (viremic HCC). We also evaluated overall survival in the two groups using propensity score-matching methods. Results: At HCC diagnosis, compared to viremic HCC, post-SVR HCC patients were older, less obese, less likely cirrhotic, with better liver function, lower alpha-fetoprotein levels, earlier BCLC stages, and higher rate of treatment with surgery. Overall, post-SVR HCC patients had higher median survival than viremic patients (153.3 vs 55.6 months, P < 0.01), but post-SVR HCC (vs viremic HCC) was not independently associated with survival on multivariate analysis (adjusted HR: 1.05, 95% CI: 0.76–1.47). However, on sub-analysis, viremic HCC patients who subsequently received anti-viral treatment and achieved SVR had higher median survival than post-SVR HCC patients (P < 0.01). Viremic HCC with subsequent SVR was also significantly associated with lower mortality as compared to post-SVR HCC (adjusted HR: 0.18, 95% CI: 0.11–0.29). In addition, we observed similar findings in our analysis of the propensity score-matched cohorts. Conclusion: The advantages in clinical and tumor characters at HCC diagnosis determined the better overall survival of patients with post-SVR HCC; however, HCV eradication after HCC development was also associated with improved survival.