Survival data among patients with HCV-related HCC after achieving sustained virologic response (SVR) with interferon (IFN)-free direct acting antivirals (DAAs) in both Asian and western countries are limited. Survival rates were compared between HCV-related HCC patients who were untreated for HCV and those who achieved SVR. Using data from two U.S. and six Asian centers from 2005-2017, we categorized 1676 mono-infected HCV-related HCC patients into patients untreated for HCV (untreated group) and DAA-treated patients with SVR (SVR group) and matched by propensity score-matching (PSM); multivariable Cox regression with HCV treatment status as a time-varying covariate was used to determine mortality risk and landmark analysis to avoid immortal time bias. There were 1,239 untreated and 437 SVR patients. After PSM, background risks of the 321 pairs of matched patients were balanced (all P>0.05). After time-varying adjustment for HCV treatment initiation compared to untreated patients, SVR patients had significantly higher 5-year overall survival (87.78% vs. 66.05%, P<0.001). Multivariable Cox regression showed that SVR was independently associated with a 63% lower risk of 5-year all-cause mortality (HR=0.37; 95% CI: 0.16-0.83, P=0.016) and 66% lower risk of 5-year liver-related mortality (HR=0.34; 95% CI: 0.13-0.88, P=0.026) with similar trends after removing liver transplanted patients. Landmark analysis at 90, 180, and 360 days showed consistent results (HRs ranged 0.22 to 0.44, all P<0.05). CONCLUSION: In this multinational consortium, HCV-related HCC patients who obtained SVR achieved a 60-70% improvement in 5-year survival (both all-cause and liver-related) compared to patients untreated for HCV. Patients eligible for HCC therapy should also be considered for DAA therapy.
View details for DOI 10.1002/hep.30988
View details for PubMedID 31610027