Published online Jun 28, 2018. doi: 10.3748/wjg.v24.i24.2582
Peer-review started: April 21, 2018
First decision: May 9, 2018
Revised: May 18, 2018
Accepted: June 9, 2018
Article in press: June 12, 2018
Published online: June 28, 2018
Processing time: 67 Days and 8.2 Hours
With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum “not well-defined” follow-up: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection.
Core tip: A significant debate about the impact of direct-acting antiviral agents (DAAs) on the development of hepatocellular carcinoma (HCC) is currently ongoing. After a full review of the published literature, the evidence does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous hepatitis C virus infection.