DAA Treatment Leads to Liver Improvement Following Surgery

Direct-acting antiviral (DAA) therapy following liver surgery for hepatocellular carcinoma (HCC) caused by hepatitis C virus (HCV) infections extends post-surgery survival, according to new data.

A team, led by Shogo Tanaka, Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, investigators the effect of DAA-induced sustained virological response following liver resection in patients with HCV-related hepatocellular carcinoma for postoperative recurrence and survival.

In recent years, DAA has become the standard of treatments for HCV infections, with evidence showing low rates of HCR in patients with DAA-induced SVR compared to patients with no treatment for HCV infections or non-DAA-induced SVR.

“On the other hand, whether DAA-induced SVR before and after liver resection affects postoperative recurrence and prognosis has not been clarified,” the authors wrote. “Preoperative and postoperative IBT-induced SVR was reported to suppressed HCC recurrence after liver resection, in comparison with no treatments or non–IBT-induced SVR.”

The Study

In the study, the investigators examined the outcomes in 18 patients with postoperative DAA-induced SVR, compared to 23 patients with postoperative DAA-induced SVR and 10 patients who did not receive DAA therapy as a control group between September 2014 and December 2019.

During this time period there were 119 patients who were seropositive for HCV antibody and seronegative for hepatitis B surface antigens who underwent hepatic resection for initial HCC.

The median duration from the conclusion of DAA therapy to the detection of HCC was 754 days in the DAA-FCC group and the median duration from liver

Results

A year following surgery, serum concentrations of aminotransferases improved in both the HCC-DAA and DAA-HCC groups.

In addition, there were 15 HCC-AA patients with albumin-bilirubin grade 1, an increase from 11 at baseline.

One metric that did not differ between the 3 groups was the disease-free survival rate, which was 60% at year 3 for the HCC-DAA group, 92% for the DAA-HCC group and 60% for the control group.

However, the 3-year overall survival rates were highest in the 2 study groups in comparison with the control group. The rate was 84% in the DAA-HCC group and 100% in the HCC-DAA group, compared to just 46% in the control group (all P <0.05 according to Hohn’s test).

The investigators also used multivariable analysis that showed tumor stage was an independent risk factor for postoperative recurrence, while ALBI grade at the 1 year mark following surgery was predictive of postoperative survival. However, DAA-induced SVR was neither.

“Although postoperative DAA-induced SVR itself may not suppress postoperative recurrence, improvement in liver function as a result of DAA administration after surgery may prolong postoperative survival,” the authors wrote. “This study indicated that the effect of DAA-induced SVR after liver resection for HCV-related HCC on postoperative survival did not differ from that of HCC detected after DAA-induced SVR or that of no use of the DAA therapy.”

The study, “Postoperative direct-acting antiviral treatment after liver resection in patients with hepatitis C virus-related hepatocellular carcinoma,” was published online in Hepatology Research.