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Dai et al. Hepatoma Res 2020;6:16 I http://dx.doi.org/10.20517/2394-5079.2019.40 Page 7 of 9

There are some limitations in the present study. Firstly, a retrospective observational study design may
possess some selection bias in obtaining the real efficacy of the therapy. Secondly, we did not record the
real-world withdrawal rate of the HCC patients receiving the DAAs although the treatment duration was
shortened and the potency increased by the currently widely used DAAs, which may have improved the rate
of complete treatment and discontinuation significantly. Thirdly, with a high cure rate for HCV, we did not
observe any impact of the DAA therapy on the natural course of the HCC. The controversies of the influence
of HCV therapy by DAAs have been discussed with more evidence from the recent systematic reviews and
meta-analyses disputing the unfavorable effects on the development of more advanced recurrence or early
[35]
recurrence in patients with HCC . Lastly, because of the relatively small number of HCC patients treated
by DAAs in our study, the statistical non-significance in HCC and non-HCC patients possibly needs further
large-scale studies for validation.

In conclusion, we have demonstrated similar SVR rates in patients with HCC, either active or inactive,
receiving a complete course of potent DAAs in Taiwan. With high potent DAAs available and easier and
more convenient care including shorter duration and less adverse effects during treatment, our results
suggest the importance of adherence to DAA therapy and the preference of treating HCV aggressively for
HCC patients in clinical settings in Taiwan.

DECLARATIONS
Authors’ contributions
Conceived and planned the experiments: Dai CY, Huang CF, Chuang WL, Yu ML
Performed the analytic calculations: Dai CY, Huang CF, Tsai PC, Lin CC, Yu ML
Contributed to patient and sample preparation: Dai CY, Huang CF, Hsieh MH, Huang CI, Yeh ML, Yang JF,
Wei YJ, Hsu CT, Liang PC, Lin YH, Huang JF, Chuang WL, Yu ML
Contributed to the interpretation of the results: Dai CY, Huang CF, Tsai PC, Lin CC, Lee MS, Chuang WL,
Yu ML
Took the lead in writing the manuscript: Dai CY, Huang CF, Yu ML
Supervised the project: Yu ML

Availability of data and materials
The data source came from Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical
University Hospital. Data could be released to the public only when approval of the owner.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The institutional review board of the Kaohsiung Medical University Hospital approved the protocols, which
followed the guidelines of the International Conference on Harmonization for Good Clinical Practice. All
patients provided written informed consent. There was no specific ethic consideration during the study.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.