Current Status of Hepatocellular Carcinoma Occurrence after Achieving a Sustained Virologic Response with Direct-Acting Antiviral Drug Treatment for Type C Chronic Liver Disease: A Study at Kawasaki Municipal Tama Hospital

抄録

With the development of direct-acting antiviral (DAA) treatment for chronic hepatitis C including liver cirrhosis (type C chronic liver disease; type C CLD), almost 100% virus elimination can be achieved. DAA treatment is also being expanded for elderly patients and/or patients with advanced fibrosis. Therefore, there is a concern that the risk of hepatocellular carcinoma (HCC) after DAA treatment may increase. We examined the current status of HCC occurrence in 241 patients who achieved a sustained virologic response (SVR) upon DAA treatment for type C CLD with no history of liver cancer. HCC was developed in 12 patients (5.0%), and the cumulative incidence rate was 1.3% for 1 year, 3.1% for 2 years, 3.6% for 3 years, 4.7% for 4 years, and 6.4% for 5 years, respectively. Moreover, the rate of HCC incidence was significantly higher in elderly patients (≧70 years old; P=0.0488). Nine cases were diagnosed as HCC stages I and II, and the prognosis was favorable with proper treatment. The remaining three cases were suspected to rapidly progress toward advanced HCC, diagnosed as stage III and IV at the time of diagnosis; all the patients died within a year. Consequently, post-SVR HCC occurrence after DAA treatment should be carefully followed on a case-by-case basis, especially in the elderly and in patients with advanced fibrosis.