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Page 4 of 5 Krastev et al. Hepatoma Res 2019;5:35 I http://dx.doi.org/10.20517/2394-5079.2019.02

HCC recurrence after SVR
February 2018, 37 months after RFA and 34 months after SVR12, the patient was admitted for clinical
follow-up. Using contrast enhanced ultrasound and contrast-enhanced computed tomography (CT)-scan
a recurrent HCC nodule, 25 mm × 20 mm in size, was detected in the same liver segment. The chronic
liver disease was compensated, but with signs of progression of the portal hypertension with grade 3
gastroesophageal varices. Serum HCV RNA and HBV DNA were undetectable.

In March, 2018 microwave ablation and percutaneous ethanol injection were performed in the detected
vital HCC nodule. Following CT-scan confirmed absence of vital tissue in the malignant nodule, with axial
dimensions of the ablated zone 56 mm × 49 mm.

One year later, due to progression Sorafenib therapy was initiated.

DISCUSSION

The initial data that indicated increased risks of HCC recurrence after DAAs therapy have not been
[12]
confirmed by subsequent studies, but the discussed problem is still a matter of debate . In our case report,
the late HCC recurrence is more likely to be a result of the evolution of long-lasting liver cirrhosis, rather
than to the performed DAAs treatment. The discussed subject was with history of cirrhosis for more than
18 years and HCC initially occurred prior to DAAs therapy. Although, HCC was diagnosed in early stage
(BCLC-A) complete destruction prior DAAs therapy was achieved by multiple sessions of local therapy
(TACE and RFAs). Patients who underwent more than one HCC treatment had a higher recurrence rate than
those treated only once [12-15] .

In another case, series of cirrhosis associated with HCV done in Bulgaria, more advanced HCCs were
successfully treated with percutaneous thermal ablation (n = 17) or resection (n = 1). Subsequently, all
patients were treated with DAA for HCV infection. HCC recidivism (local or distal intrahepatic) was
observed in 13 patients (72%) (18, personal communication). Of particular importance is that subject was
anti-HBc positive. Anti-HBc has also been shown to be prognostic factor in HCC recurrence and recurrence
free survival after curative resection [16,17] . On the other hand, HCC recurrence was detected relatively late -
37 months post initial complete destruction of HCC.

The natural history of viral liver cirrhosis includes HCC development. Suppression of viral replication
reduces the rate of HCC occurrence. The local therapy is successful in the early stage of HCC, but did not
eliminate the risk of HCC recurrence. The new DAA therapy is very short. Some communications reported
an unexpectedly high rate of HCC reoccurrence after DAA therapy, but this was not confirmed by further
studies. In our case the delayed HCC recurrence might be associated not only with HCV eradication but
long term disease and past HBV.

DECLARATIONS
Authors’ contributions
Study concept and design, literature search, drafting the manuscript: Krastev Z, Jelev D, Krasteva D, Genov
J, Komitova T

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.