Effect of antiviral treatment for hepatitis C virus on long-term outcomes in patients undergoing resection for hepatocellular carcinoma

Hepatitis C virus infection is a risk factor for hepatocellular carcinoma (HCC). The effect of direct-acting antivirals on prognoses remains unclear. We assessed the prognosis of patients receiving direct-acting antiviral and interferon treatment after the initial resection of hepatitis C virus-related HCC. We retrospectively analyzed patients who underwent initial hepatitis C virus-related HCC resection at The University of Tokyo Hospital between June 2009 and December 2022. Recurrence-free survival (RFS) and overall survival (OS) were assessed using the log-rank test. Cox proportional hazards model analysis was performed to identify the risk factors for RFS and OS. Of 756 patients who underwent HCC resection, 142 had hepatitis C virus-related HCC. Among them, the 5-year OS was significantly better in those receiving antiviral treatment than in those without antiviral treatment (72.2 % vs. 48.9 %, P < 0.001); however, RFS did not differ between the groups (P = 0.35). RFS and OS did not differ significantly between patients who received direct-acting antivirals and those who received interferon (P = 0.09 and P = 0.47, respectively). RFS and OS did not differ significantly between patients receiving antiviral treatment before surgery and those after surgery (P = 0.11 and P = 0.23, respectively). Antiviral treatment improved postoperative prognosis; however, the prognosis did not differ between the types of antiviral treatment in patients with hepatitis C virus-related hepatocellular carcinoma. • OS was significantly better in patients who received antiviral treatments than in those who did not. • RFS was not significantly different between patients who received antiviral treatment and those who did not. • HCV treatment type (IFN vs. DAAs) was not associated with RFS or OS in patients undergoing initial C-HCC resection. • The timing (before or after liver resection) of HCV treatment did not influence prognoses after liver resection. • DAAs remain the first choice of HCV treatment in terms of RFS, OS, and the high rate of SVR.