Effect of Direct-Acting Antivirals on Prognosis in Older Patients With Hepatitis C Virus-Related Hepatocellular Carcinoma After Curative Therapy: A Retrospective Study by the Red Cross Liver Study Group in Japan.

[AIM] Reports on the effects of hepatitis C virus (HCV) clearance through direct-acting antiviral (DAA) administration after hepatocellular carcinoma (HCC) treatment on survival and recurrence rates in older patients remain limited. We examined the effects of DAA administration after HCC treatment in patients aged ≥ 75 years on survival and recurrence rates.

[METHODS] This present retrospective multicenter study included patients aged ≥ 75 years with HCV-related HCC who received DAA within 12 months after HCC treatment (DAA group) and patients without DAA for HCV-related HCC (non-DAA group). Cases were classified as Barcelona Clinic Liver Cancer stage A or 0, limiting treatment method to liver resection and radiofrequency ablation. Propensity score matching was carried out, and patient's prognoses were examined.

[RESULTS] After matching, each group included 43 patients. In the DAA and non-DAA groups, respectively, the 5-year overall survival rates were 76.3% and 49.1% (p = 0.024) whereas 5-year cumulative recurrence rates were 61.7% and 92.4% (p < 0.001). Cox proportional hazards model (reporting hazard ratio and 95% confidence interval) showed DAA use as significantly associated with overall survival (p = 0.03; 0.47; and 0.23-0.93) and recurrence (p = 0.002; 0.45; and 0.27-0.74). The 5-year median albumin-bilirubin score was -2.77 (DAA group, n = 16) and -2.36 (non-DAA group, n = 12) (p = 0.002). DAA group had fewer deaths due to liver disease than non-DAA group; however, the number of deaths due to nonliver diseases was almost same.

[CONCLUSIONS] DAA improved hepatic reserve function and improved survival and recurrence rates after HCC treatment in patients aged ≥ 75 years and should be administered after assessing the status of comorbidities.