Abstract
Background
The achievement of high rates of sustained virological response (SVR) with direct-acting
antivirals (DAAs) in hepatitis C virus (HCV) infected patients will reduce decompensating
terminal events.
Aims
To investigate whether hepatocellular carcinoma (HCC) occurrence could change due
to the DAA-induced increase in life-expectancy.
Methods
A Markov model was built on clinical data of 494 cirrhotic patients and available
literature to estimate probabilities of “death before HCC” and of “HCC occurrence”
without and with DAA.
Results
In comparison to untreated patients, DAA therapy reduced the 20-year mortality before
HCC by 21.9% in patients without varices and by 21.5% in those with varices, considering
an SVR of 95% and no direct effect on hepatocarcinogenesis. Tumour occurrence increased
by 5%–8.2% and the proportion of HCCs diagnosed in compensated stages increased to
>98%. If we consider DAA as having “anti-tumoral” effects, the benefit becomes greater,
achieving a 20-year survival of 81.5% in patients without varices, and 52.2% in patients
with varices. Instead, if we consider DAA as having a “pro-tumoral” effect, then,
the increased incidence of HCC nullifies the survival benefits.
Conclusion
DAAs drastically reduce the mortality caused by the liver function worsening, increasing
the proportion of HCCs diagnosed in compensated stages. Knowledge of the DAA effect
on hepatocarcinogenesis remains pivotal.
Keywords
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Article info
Publication history
Published online: October 18, 2017
Accepted:
October 9,
2017
Received in revised form:
October 9,
2017
Received:
April 27,
2017
Identification
Copyright
© 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
