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Russo et al. Hepatoma Research 2018;4:25 Hepatoma Research
DOI: 10.20517/2394-5079.2018.52

Review Open Access

HCV clearance by direct antiviral therapy and
occurrence/recurrence of hepatocellular carcinoma:
still an issue?

Francesco Paolo Russo, Martina Tessari, Angela Imondi, Erica Nicola Lynch, Fabio Farinati
Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, Padua University Hospital, Padua 35128, Italy.

Correspondence to: Prof. Fabio Farinati, Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, Padua
University Hospital, Via Giustiniani 2, Padua 35128, Italy. E-mail: fabio.farinati@unipd.it

How to cite this article: Russo FP, Tessari M, Imondi A, Lynch EN, Farinati F. HCV clearance by direct antiviral therapy and occurrence/
recurrence of hepatocellular carcinoma: still an issue? Hepatoma Res 2018;4:25. http://dx.doi.org/10.20517/2394-5079.2018.52

Received: 4 May 2018 First Decision: 15 May 2018 Revised: 10 Jun 2018 Accepted: 16 Jun 2018 Published: 27 Jun 2018
Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
New regimens with direct-acting antivirals (DAAs) agents have changed both efficacy and safety of hepatitis C
virus (HCV)-treatment, as almost all patients can be treated and cured at any stage of liver disease. The rates
of sustained virological response to currently available combinations exceed 95% in real-life practice. However,
conflicting results have been produced on the occurrence/recurrence of hepatocellular carcinoma (HCC) in
patients with HCV-associated cirrhosis treated with DAAs. In this review we analyse the data available in the
literature in order to elucidate the impact of DAAs on the risk of HCC occurrence in patients without previous
history of tumor, and of recurrence after successful treatment of the tumor. Data on “de novo” HCC incidence
were quite homogeneous, suggesting that the treatment with DAAs does not modify the risk of HCC developing
during the first 6-12 months after HCV eradication. On the contrary, HCC recurrence rates after DAAs were
extremely variable across different studies, reflecting a large heterogeneity in this clinical setting. The possibility
that treatment with DAAs may favour tumour growth and spread in individual patients with active HCC foci is
supported by some observations but remains unproven.

Keywords: Hepatitis C virus, direct-acting antivirals, eradication, hepatocellular carcinoma, occurrence, recurrence

INTRODUCTION
Patients with hepatitis C infection (HCV) and cirrhosis have an increased risk of developing liver
decompensation (LD), hepatocellular carcinoma (HCC) and liver-related death (LRD). Cirrhosis is a major
risk factor for the development of HCC in Western countries, where HCC occurs at an average annual
[1,2]
rate of 3%-5% in cirrhotic patients . Data on the long-term outcome of patients with HCV infections,
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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