Effects of Achieving SVR on Clinical Characteristics and Surgical Outcomes in Patients Who Developed Early-Stage HCV-Related Hepatocellular Carcinoma and Received Curative Resection: Preoperative versus Postoperative SVR

Abstract

The high accessibility to healthcare and increasing awareness of hepatocellular carcinoma (HCC) surveillance after sustained virologic response (SVR) to HCV treatment allow early detection of operable HCC in Taiwan. However, the effects of achieving SVR on patient characteristics and surgical outcomes after curative resection remain elusive. We aimed to compare the clinical presentation and postoperative prognosis among patients with early-stage HCV-related HCC and different viral status. We retrospectively analyzed 208 patients with BCLC stage 0 or A-HCC, including 44 patients who remained HCV viremic, 90 patients who developed HCC after achieving SVR (post-SVR HCC), and 74 patients who subsequently achieved SVR after resection. Patients with post-SVR HCC had a lower degree of hepatitis and better liver function than those who achieved SVR or remained viremic after resection. Notably, 75.6% of patients with post-SVR HCC did not have cirrhosis. Patients with post-SVR HCC and those achieving SVR after resection exhibited comparable recurrence rates and recurrence-free survival, while patients with persistent viremia had the worst surgical outcomes. We concluded that patients with post-SVR HCC had a better liver function but similar surgical outcomes compared with patients who achieved SVR after resection. The low prevalence of cirrhosis in patients with post-SVR HCC highlights the importance of regular surveillance after SVR.

Perioperative predictors of outcome of hepatectomy for HBV-related hepatocellular carcinoma

“…Whether SVR is achieved preoperatively or postoperatively, it is associated with better prognoses of HCV-related HCC ( 135 , 136 ). Further research suggested that preoperative SVR is more beneficial than postoperative SVR, with similar surgical outcomes but better postoperative liver function ( 137 – 139 ).…”

Epigenetic memory of environmental exposures as a mediator of liver disease

“…[45] Individuals who achieved HCV SVR before or after HCC resection showed similar recurrence and progression-free survival, with non-SVR HCV patients presenting with a higher rate of recurrence and lower progression-free survival. [46] Bariatric surgery as a means to treat obesity driven metabolic syndrome also reduces HCC risk [47] and leads to regression of fibrosis in 70% of patients 5 years after surgery. [48] In 1992, it was reported that both prior and ongoing alcohol consumption increased risk for cirrhosis.…”

“…In fact, the risk of progression to HCC goes beyond measures of patient liver fibrosis, and combining viral status with fibrosis, age, fibroscan assessments, and a battery of serologic tests like FIB-4, further enhances risk stratification 45. Individuals who achieved HCV SVR before or after HCC resection showed similar recurrence and progression-free survival, with non-SVR HCV patients presenting with a higher rate of recurrence and lower progression-free survival 46. Bariatric surgery as a means to treat obesity driven metabolic syndrome also reduces HCC risk47 and leads to regression of fibrosis in 70% of patients 5 years after surgery 48.…”

Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Genotype Iii and Advanced Hepatic Fibrosis After Treatment With Direct-Acting Antivirals

“…However, it is still unclear whether the SVR in such patients impacts the risk of developing HCC. Multiple retrospective studies conducted in heterogeneous subjects have reported the increased risk of HCC in such cases, while others contradict these conclusions (Hsu et al, 2022;Yeh et al, 2021). This study was conducted to assess the incidence of hepatocellular carcinoma in chronic hepatitis C patients genotype III with hepatic fibrosis or cirrhosis after achievement of sustained viral response after treatment with direct acting antivirals.…”