PT - JOURNAL ARTICLE AU - Victor Sapena AU - Marco Enea AU - Ferran Torres AU - Ciro Celsa AU - Jose Rios AU - Giacomo Emanuele Maria Rizzo AU - Pierre Nahon AU - Zoe Mariño AU - Ryosuke Tateishi AU - Tatsuya Minami AU - Angelo Sangiovanni AU - Xavier Forns AU - Hidenori Toyoda AU - Stefano Brillanti AU - Fabio Conti AU - Elisabetta Degasperi AU - Ming-Lung Yu AU - Pei-Chien Tsai AU - Kevin Jean AU - Mohamed El Kassas AU - Hend Ibrahim Shousha AU - Ashraf Omar AU - Claudio Zavaglia AU - Hiroko Nagata AU - Mina Nakagawa AU - Yasuhiro Asahina AU - Amit G Singal AU - Caitlin Murphy AU - Mohamed Kohla AU - Chiara Masetti AU - Jean-François Dufour AU - Nicolas Merchante AU - Luisa Cavalletto AU - liliana LC chemello AU - Stanislas POL AU - Javier Crespo AU - Jose Luis Calleja AU - Rosanna Villani AU - Gaetano Serviddio AU - Alberto Zanetto AU - Sarah Shalaby AU - Francesco Paolo Russo AU - Rob Bielen AU - Franco Trevisani AU - Calogero Cammà AU - Jordi Bruix AU - Giuseppe Cabibbo AU - Maria Reig TI - Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis AID - 10.1136/gutjnl-2020-323663 DP - 2021 Mar 19 TA - Gut PG - gutjnl-2020-323663 4099 - http://gut.bmj.com/content/early/2021/03/18/gutjnl-2020-323663.short 4100 - http://gut.bmj.com/content/early/2021/03/18/gutjnl-2020-323663.full AB - Objective The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration.Design We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson.Results Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1).Conclusion Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.