TY - JOUR
T1 - Direct-acting antivirals lower mortality and recurrence in HCV-related hepatocellular carcinoma post liver resection
T2 - A multicenter international study
AU - Choi, Woo Jin
AU - Ivanics, Tommy
AU - Claasen, Marco
AU - Magyar, Christian T.J.
AU - Li, Zhihao
AU - Tabrizian, Parissa
AU - Rocha, Chiara
AU - Myers, Bryan
AU - O'Kane, Grainne M.
AU - Reig, Maria
AU - Ferrer Fàbrega, Joana
AU - Holgin, Victor
AU - Parikh, Neehar D.
AU - Pillai, Anjana
AU - Hunold, Thomas M.
AU - Vogel, Arndt
AU - Patel, Madhukar S.
AU - Singal, Amit G.
AU - Tadros, Meena
AU - Feld, Jordan J.
AU - Hansen, Bettina
AU - Sapisochin, Gonzalo
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/7
Y1 - 2025/7
N2 - Background: The impact of treatment on hepatitis C virus with direct-acting antivirals on 90-day postoperative outcomes, overall survival, and recurrence-free survival in patients after liver resection for hepatocellular carcinoma is unknown. Methods: We conducted a multicenter retrospective study. Adults who underwent liver resection for hepatitis C virus–related hepatocellular carcinoma between January 2000 and December 2018 were included from 7 international institutions. Groups included direct-acting antiviral treated, non–direct-acting antiviral treated, and untreated hepatitis C virus infection. We used a multivariable model to evaluate the association between receipt of preoperative direct-acting antivirals and 90-day postoperative major complications (Clavien-Dindo class ≥III). Results: We identified 738 patients, including 206 (28%) direct-acting antiviral treated, 241 (33%) non–direct-acting antiviral treated, and 291 (39%) untreated patients. The sustained virologic response rate was 92% in the direct-acting antiviral and 71% in the non–direct-acting antiviral treatment groups. The median follow-up was 7.6 years (95% confidence interval 6.1, 8.6) after surgery for the entire cohort. Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those without antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.26 [0.19, 0.35] and 0.52 [0.43, 0.64], respectively). Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those who received non–direct-acting antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.49 [0.36, 0.66] and 0.78 [0.63, 0.96], respectively). There was no significant association between preoperative direct-acting antiviral therapy and 90-day postoperative major complications (adjusted odds ratio 0.34, 95% confidence interval 0.08, 1.01). Conclusion: Direct-acting antiviral therapy is associated with improved 5-year overall and recurrence-free survival, without significantly increased risk of 90-day postoperative complications, in patients undergoing liver resection for hepatitis C virus–related hepatocellular carcinoma.
AB - Background: The impact of treatment on hepatitis C virus with direct-acting antivirals on 90-day postoperative outcomes, overall survival, and recurrence-free survival in patients after liver resection for hepatocellular carcinoma is unknown. Methods: We conducted a multicenter retrospective study. Adults who underwent liver resection for hepatitis C virus–related hepatocellular carcinoma between January 2000 and December 2018 were included from 7 international institutions. Groups included direct-acting antiviral treated, non–direct-acting antiviral treated, and untreated hepatitis C virus infection. We used a multivariable model to evaluate the association between receipt of preoperative direct-acting antivirals and 90-day postoperative major complications (Clavien-Dindo class ≥III). Results: We identified 738 patients, including 206 (28%) direct-acting antiviral treated, 241 (33%) non–direct-acting antiviral treated, and 291 (39%) untreated patients. The sustained virologic response rate was 92% in the direct-acting antiviral and 71% in the non–direct-acting antiviral treatment groups. The median follow-up was 7.6 years (95% confidence interval 6.1, 8.6) after surgery for the entire cohort. Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those without antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.26 [0.19, 0.35] and 0.52 [0.43, 0.64], respectively). Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those who received non–direct-acting antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.49 [0.36, 0.66] and 0.78 [0.63, 0.96], respectively). There was no significant association between preoperative direct-acting antiviral therapy and 90-day postoperative major complications (adjusted odds ratio 0.34, 95% confidence interval 0.08, 1.01). Conclusion: Direct-acting antiviral therapy is associated with improved 5-year overall and recurrence-free survival, without significantly increased risk of 90-day postoperative complications, in patients undergoing liver resection for hepatitis C virus–related hepatocellular carcinoma.
UR - https://www.scopus.com/pages/publications/105004311812
U2 - 10.1016/j.surg.2025.109396
DO - 10.1016/j.surg.2025.109396
M3 - Article
AN - SCOPUS:105004311812
SN - 0039-6060
VL - 183
JO - Surgery (United States)
JF - Surgery (United States)
M1 - 109396
ER -