Efficacy and Long-Term Outcomes of Direct-Acting Antivirals in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Background/Aims: The role of direct-acting antivirals (DAAs) in patients with hepatocellular carcinoma (HCC) remains uncertain due to conflicting data on virologic efficacy and long-term outcomes. Methods: This meta-analysis investigated studies reporting the sustained virologic response (SVR), recurrence, and overall survival in patients with HCC treated with DAAs. Results: Eighty-eight studies were included, comprising 8,839 patients with HCC who were treated with DAAs. The pooled SVR rate in patients with HCC was 89% (95% confidence interval [CI], 87% to 91%). However, the SVR varied significantly depending on tumor viability; patients with non-viable HCC had the highest SVR (91%), followed by those with mixed (88%) and viable HCC (84%). The SVR was significantly lower in the HCC group than in the non-HCC group (risk ratio [RR], 0.95; 95% CI, 0.92 to 0.98). In 28 studies reporting on recurrence outcomes, patients with HCC who were treated with DAAs had a 40% lower recurrence risk than non-DAA-treated patients (RR, 0.60; 95% CI, 0.49 to 0.75). Pooled analyses of adjusted estimates showed that DAA treatment was independently associated with reduced recurrence (hazard ratio [HR], 0.47; 95% CI, 0.32 to 0.70) and all-cause mortality (HR, 0.40; 95% CI, 0.31 to 0.51). An SVR was linked to an improved prognosis, with lower recurrence (HR, 0.43; 95% CI, 0.31 to 0.61) and mortality (HR, 0.41; 95% CI, 0.14 to 1.24) risks. Conclusions: DAAs are effective in patients with HCC. Despite slightly lower SVR rates than in patients without HCC, the overall benefits support the use of antiviral therapy in patients with HCC.