Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis
This is the report of an individual patient data meta-analysis, including 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Recurrence rate and death risk per 100PY (100 person-years) in DAA-treated patients were 20 (95% CI 13.9-29.8, I2=74.6%) and 5.7 (2.5-15.3, I2=54.3). Predictive factors for recurrence were AFP logarithm (relative risk (RR)=1.11, 95% CI 1.03-1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07-1.16; p<0.001), ECOG PS (2 vs 0, RR=4.35, 95% CI 1.54-11.11; 2 vs 1, RR=3.7, 95% CI 1.3-11.11; p=0.01), and tumor burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25-2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37-1.1; p=0.1).