# Risk for Recurrence After Liver Resection in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma Detected After Sustained Virological Response by Direct-Acting Antivirals: A Retrospective Multicenter Study

## TL;DR

This study finds that alcohol abuse and tumor size are risk factors for liver cancer recurrence after surgery in patients who achieved a hepatitis C cure with new drugs.

## Contribution

Identifies alcohol abuse as a novel independent risk factor for HCC recurrence after liver resection post-DAA SVR.

## Key findings

- 3- and 5-year disease-free survival rates after liver resection were 68.7% and 55.3%.
- Alcohol abuse and tumor size were independent risk factors for postoperative recurrence.
- Patients without alcohol abuse had significantly better survival rates than those with alcohol abuse.

## Abstract

The risk factors for postoperative recurrence in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) detected after the achievement of a sustained virological response (SVR) by direct-acting antivirals (DAAs) are unknown. The clinical records of 95 patients with initial HCV-related HCC detected after DAA-SVR achievement, who underwent liver resection, were retrospectively reviewed. The 3- and 5-year disease-free survival (DFS) rates after liver resection were 68.7% and 55.3%, respectively. Univariate and multivariate analyses identified alcohol abuse and tumor size as independent risk factors for postoperative recurrence. Continuous alcohol abuse is a risk factor for recurrence after surgery of HCC detected after the achievement of DAA-SVR.

Backgrounds: Direct-acting antiviral (DAA) therapy, which achieves a high sustained virological response (SVR) rate, has been established as a standard treatment for patients with hepatitis C virus (HCV) infection. However, the risk factors for postoperative recurrence in patients with HCV-related hepatocellular carcinoma (HCC) detected after the achievement of an SVR by DAAs are unknown. Methods: The clinical records of 95 patients with initial HCV-related HCC detected after DAA-SVR achievement, who underwent liver resection between September 2014 and December 2020, were retrospectively reviewed. Patients with major vascular invasion and/or SVR achievement induced by interferon-based therapy were excluded. In this study, the patients were divided into two groups according to their alcohol intake status: without alcohol abuse (<80 g of ethanol each day for at least 5 years, n = 85) and with (continuous) alcohol abuse (n = 10). The risk factors for recurrence after liver resection were investigated, with special reference to the alcohol intake status. Results: The 3- and 5-year disease-free survival (DFS) rates after liver resection were 68.7% and 55.3%, respectively. Univariate and multivariate analyses identified alcohol abuse [hazard ratio (HR) 3.36, p = 0.004] and tumor size (HR 2.53, p = 0.010) as independent risk factors for postoperative recurrence. The 3- and 5-year postoperative DFS rates were 72.2% and 61.5% for patients without alcohol abuse and 40.0% and 13.3% for those with alcohol abuse (p = 0.001). Conclusions: Continuous alcohol abuse is a risk factor for recurrence after surgery of HCC detected after the achievement of DAA-SVR.