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Hepatocellular carcinoma before and after the era of direct-acting antiviral therapy for chronic hepatitis C: Dose the story differ?

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Last updated: 23 Dec 2024

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Abstract

Background. Hepatitis C virus (HCV) infection is a leading cause of liver cancer globally. Treating chronic HCV with direct-acting antivirals (DAAs) in cirrhotic patients has raised concerns about their effect on HCC development and progr-ession. Objective: To compare the characteristics of de novo HCC in chronic HCV cirrhotic patients who achieved susta-ined virological response (SVR) with DAAs therapy, with that of HCC which developed in chronic HCV cirrhotic patients who did not receive DAAs or PEG interferon-based treatments. Methods The study included 200 chronic HCV cirrhotic patients divided into two groups: group 1 with 100 patients who developed de novo HCC post-SVR following DAAs, and group 2 with 100 HCV-related HCC patients who developed HCC without prior antiviral therapy. Non-invasive HCC diagnosis was based on EASL guidelines. Baseline demogr-aphic, clinical, and laboratory data were collected. The Child-Turcotte-Pugh (CTP) score, class, and Barcelona Clinic Liver Cancer (BCLC) staging system were determined (stages 0/A as early stages, while BCLC stages B/C/D as late stages of HCC). The types of DAAs used for chronic HCV treatment were also recorded. Results. Post-DAAs HCC was diagnosed approximately 4.3 years post-SVR, characterized by multi-focal or diffuse infiltration compared to HCV-related HCC. The tumor diameter in post-DAAs HCC was larger versus in HCV-related HCC (p= 0.002). Linear regression analysis indicated that DAAs therapy was a significant predictor of a larger tumor diameter. Malignant portal vein thrombosis (PVT) was more prevalent in post-DAAs HCC compared to HCV-related HCC (p= 0.001). CTP score was significantly lower in post-DAAs HCC compared to HCV-related HCC (p < .001). Post-DAAs HCC was diagnosed at later BCLC stages than HCV-related HCC. The serum AFP level was insignificantly higher in post-DAAs HCC than in HCV-related HCC. Platelets were significantly higher in post-DAAs HCC than in HCV-related HCC (p= 0.001). ALT levels were significantly lower in post-DAAs HCC compared to HCV-related HCC (p=0.02). Conclusion Post-DAAs HCC had larger size, a more diffuse pattern, and a higher rate of malignant PVT compared to HCV-related HCC. It was diagnosed at later BCLC stages but had lower CTP scores, lower ALT levels, and higher platelet counts.

DOI

10.21608/mjvh.2024.350728

Keywords

Hepatocellular carcinoma, Chronic hepatitis C, Direct acting antivirals

Authors

First Name

Hany

Last Name

Shabana

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Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt.

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hras2010@live.com

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Orcid

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First Name

Salah

Last Name

Elgamal

MiddleName

-

Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt.

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Orcid

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First Name

Ayman

Last Name

Menessy

MiddleName

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Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt.

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Orcid

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First Name

Ehab

Last Name

Abdel-Khalek

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Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt

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Orcid

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First Name

Fatma

Last Name

Abozeid

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Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt

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Orcid

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First Name

Marwa

Last Name

Askar

MiddleName

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Affiliation

Clinical pathology dept., Mansoura New General Hospital, Ministry of Health, Egypt.

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Orcid

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First Name

Mohammed

Last Name

Mohsen

MiddleName

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Affiliation

Diagnostic Radiology dept., Mansoura University Hospital, Faculty of Medicine, Mansoura Univ., Egypt

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-

City

-

Orcid

-

First Name

Abd- Elmohsen

Last Name

El-Desoky

MiddleName

-

Affiliation

Hepatology and Gastroenterology Unit, Internal Medicine dept., Faculty of Medicine, Mansoura Univ., Egypt.

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-

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-

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Volume

8.1

Article Issue

1

Related Issue

47193

Issue Date

2024-04-01

Receive Date

2024-02-24

Publish Date

2024-05-10

Page Start

17

Page End

22

Print ISSN

2314-8748

Online ISSN

2314-8756

Link

https://mjvh.journals.ekb.eg/article_350728.html

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https://mjvh.journals.ekb.eg/service?article_code=350728

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3

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Original article

Type Code

477

Publication Type

Journal

Publication Title

Medical Journal of Viral Hepatitis

Publication Link

https://mjvh.journals.ekb.eg/

MainTitle

Hepatocellular carcinoma before and after the era of direct-acting antiviral therapy for chronic hepatitis C: Dose the story differ?

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Article

Created At

23 Dec 2024