Detailed Abstract
[Liver Best Oral Presentation - Liver (Liver Disease/Surgery)]
[LV BO-S6] Direct-acting Antiviral Therapy Is Associated with Lower Mortality And Recurrence Rate in Hepatitis C-virus Related Hepatocellular Carcinoma after Liver Resection: a Multicenter International Study
Woo Jin CHOI 1, Tommy IVANICS 1, Parissa TABRIZIAN 2, Joana FERRER-FÀBREGA 3, Neehar PARIKH 4, Anjana PILLAI 6, Arndt VOGEL 5, Jordan FELD 5, Bettina HANSEN 5, Gonzalo SAPISOCHIN 1
1 Surgery, Toronto General Hospital, CANADA, 2 Liver Transplant And Hepatobiliary Surgery, Icahn School of Medicine at Mount Sinai, UNITED STATES OF AMERICA, 3 Surgery, Hospital Clinic of Barcelona, SPAIN, 4 Gastroenterology, Hepatology And Endocrinology, University of Michigan, UNITED STATES OF AMERICA, 5 Hepatology, Toronto General Hospital, CANADA, 6 Gastroenterology, Hepatology, And Nutrition, University of Chicago Medical Center, UNITED STATES OF AMERICA
Background : The impact of direct-acting antiviral (DAA) treatment for hepatitis-C virus (HCV) on 90-day postoperative outcomes, overall survival (OS), and disease-free survival (DFS) in patients after liver resection for hepatocellular carcinoma (HCC) is unknown.
Methods : We conducted a multicenter international retrospective study. Adults who underwent liver resection for HCV-related HCC between Jan-2000 to Dec-2018 were included across seven institutions. Groups included DAA treated or untreated. A multivariable model was used to evaluate the association between receipt of preoperative DAA and 90-day postoperative major complications (Clavien-Dindo ≥ III). For survival analyses, DAA therapy was measured as a time-dependent covariate.
Results : We identified 738 patients and included 206 (28%) in the DAA group and 291 (39%) in the untreated group (remaining 241 received non-DAA antiviral therapies). The sustained virologic response rate was 92% in the DAA group. The median follow-up time was 3.6 years and 12 years for the untreated and DAA group, respectively. Recurrence-rate per 100-person-years was 10.7 (95%CI:9.4,12.3) and 18.8 (95%CI:16.7,21.1) for the DAA and untreated groups, respectively. The adjusted analysis showed no association between preoperative DAA treatment and 90-day postoperative major complications [OR: 0.57(95%CI: 0.30,1.04), p=0.07]. The hazard ratios for OS and DFS in the DAA group compared to the untreated group were 0.23 (95%CI: 0.17,0.31; p < 0.001) and 0.50 (95%CI:0.40,0.62; p < 0.001), respectively.
Conclusions : The receipt of DAA appears to be protective of 90-day postoperative major complications, OS, and DFS compared to the untreated group in the context of liver resection for HCV-related HCC.
Methods : We conducted a multicenter international retrospective study. Adults who underwent liver resection for HCV-related HCC between Jan-2000 to Dec-2018 were included across seven institutions. Groups included DAA treated or untreated. A multivariable model was used to evaluate the association between receipt of preoperative DAA and 90-day postoperative major complications (Clavien-Dindo ≥ III). For survival analyses, DAA therapy was measured as a time-dependent covariate.
Results : We identified 738 patients and included 206 (28%) in the DAA group and 291 (39%) in the untreated group (remaining 241 received non-DAA antiviral therapies). The sustained virologic response rate was 92% in the DAA group. The median follow-up time was 3.6 years and 12 years for the untreated and DAA group, respectively. Recurrence-rate per 100-person-years was 10.7 (95%CI:9.4,12.3) and 18.8 (95%CI:16.7,21.1) for the DAA and untreated groups, respectively. The adjusted analysis showed no association between preoperative DAA treatment and 90-day postoperative major complications [OR: 0.57(95%CI: 0.30,1.04), p=0.07]. The hazard ratios for OS and DFS in the DAA group compared to the untreated group were 0.23 (95%CI: 0.17,0.31; p < 0.001) and 0.50 (95%CI:0.40,0.62; p < 0.001), respectively.
Conclusions : The receipt of DAA appears to be protective of 90-day postoperative major complications, OS, and DFS compared to the untreated group in the context of liver resection for HCV-related HCC.
SESSION
Liver Best Oral Presentation
Room B 3/22/2024 1:30 PM - 2:50 PM