Impact of Sustained Virological Response on Outcomes After Hepatectomy for HCV-Related HCC

Overview

This retrospective study analyzed 75 patients with hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) who underwent curative hepatectomy, comparing those who achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy to untreated patients. The findings suggest that achieving SVR perioperatively is associated with improved long-term prognosis and survival outcomes post-hepatectomy.

Background

Hepatocellular carcinoma is a leading cause of cancer mortality worldwide, with viral hepatitis B and C as major etiologic factors. While nucleos(t)ide analog therapy improves outcomes in HBV-related HCC, the impact of HCV eradication via direct-acting antivirals on post-hepatectomy prognosis remains unclear. Sustained virological response (SVR) after DAA therapy is defined as undetectable HCV RNA 12 weeks post-treatment and has been linked to reduced HCC incidence and mortality. This study aims to clarify the effect of SVR on recurrence and survival after surgical resection in HCV-related HCC.

Data Highlights

Key Findings

• Among 75 patients with HCV-related HCC undergoing hepatectomy, 49 received perioperative DAA therapy and achieved SVR, while 26 remained untreated.
• DAA therapy was typically initiated one week before surgery to suppress viral replication early.
• Landmark analysis excluding events within three months post-surgery was performed to mitigate immortal time bias.
• SVR achievement was associated with improved overall survival and reduced tumor recurrence compared to untreated patients.
• Independent risk factors for post-operative prognosis were explored, emphasizing the prognostic benefit of viral eradication.

Clinical Implications

Perioperative administration of direct-acting antivirals to achieve sustained virological response should be considered in patients with HCV-related hepatocellular carcinoma undergoing hepatectomy to improve long-term outcomes. Early viral suppression may reduce recurrence risk and enhance survival, supporting integration of antiviral therapy into surgical management protocols.

Conclusion

Achieving sustained virological response through perioperative DAA therapy significantly benefits survival and reduces recurrence in HCV-associated HCC patients after hepatectomy. These findings underscore the importance of antiviral treatment in optimizing post-operative prognosis.

References

1. Global Cancer Statistics 2020 -- Liver Cancer Incidence and Mortality
2. Studies on Hepatectomy for HCC -- Treatment Efficacy
3. HBV Antiviral Therapy and HCC Outcomes -- Multicenter Retrospective Study
4. DAA Therapy and HCV Cure -- Definition of SVR
5. Impact of HCV Eradication on HCC Prognosis -- Retrospective Analyses