title: Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct-acting antivirals.
abstract: Hepatocellular carcinoma (HCC) represents a serious complication of HCV-related cirrhosis. New direct-acting antivirals (DAA) cure HCV infection in over 90% of patients. The aim of this study was to evaluate the early occurrence and recurrence of HCC in cirrhotic patients treated with DAA.
  
  
  
  We analysed 344 consecutive cirrhotic patients, without HCC, who were treated with DAA, and followed for 24weeks. Fifty-nine patients had previous HCC.
  
  
  
  DAA therapy induced sustained virological response in 91% of patients. During 24-week follow-up, HCC was detected in 26 patients (7.6%, 95% CI: 4.99-10.84): 17 of 59 patients (28.81%, 95% CI: 17.76-42.07) with previous HCC and 9 of 285 patients (3.16%, 95% CI: 1.45-5.90) without previous HCC. Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development, at univariate analysis. At multivariate analysis, Child-Pugh class (p=0.03, OR: 4.18, 95% CI: 1.17-14.8) and history of HCC (p<0.0001, OR: 12.0, 95% CI: 4.02-35.74) resulted independently associated with HCC development. Among the 59 patients with previous HCC, younger age and more severe liver fibrosis were significantly associated with HCC recurrence, both at univariate and at multivariate analysis.
  
  
  
  In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce occurrence of HCC, and patients previously treated for HCC have still a high risk of tumour recurrence, in the short term. For these reasons, all cirrhotic patients should be closely monitored and followed during and after antiviral therapy.
  
  
  
  New direct-acting antivirals are able to eradicate HCV infection in over 90% of patients with advanced liver disease. Unfortunately, the occurrence of liver cancer is not reduced in effectively treated cirrhotic patients. In addition, patients previously treated for HCC have still a high risk of tumour recurrence in the short term, despite DAA treatment.
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Conti
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.affiliation: Department of Digestive Diseases, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scuteri
authors.affiliation: Department of Digestive Diseases, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Crespi
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.affiliation: Division of Internal Medicine, Ospedale di Faenza, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Foschi
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lenzi
authors.affiliation: Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Verucchi
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Andreone
authors.affiliation: Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy. Electronic address: stefano.brillanti@unibo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Brillanti
mesh_terms: D000998:Antiviral Agents; D006528:Carcinoma, Hepatocellular; D019698:Hepatitis C, Chronic; D006801:Humans; D008103:Liver Cirrhosis; D008113:Liver Neoplasms; D009364:Neoplasm Recurrence, Local
chemical_list: D000998:Antiviral Agents
keywords: Cancer immunosurveillance; Cirrhosis; Direct-Acting antivirals; HCC development; HCC occurrence; HCC prevention; HCC recurrence; Hepatitis C; Hepatitis C virus; Hepatocellular carcinoma; Interferon-free therapy; Sustained virological response