Absence of Viral Replication Is Associated With Improved Outcome in Anti‐HCV‐Positive Patients With Hepatocellular Carcinoma

Background and aims: Presence of active hepatitis C virus (HCV) infection may influence the outcome of patients treated for hepatocellular carcinoma (HCC), although this issue has never been adequately assessed in a large series of patients. The aim of this study was to evaluate whether the presence of active HCV affects the survival of patients treated for HCC. Methods: This study assessed the outcome of 3123 anti-HCV-positive patients with HCC, subdivided according to the presence of active HCV infection or previous sustained virological response (SVR). Comparisons were also carried out after propensity score matching (PSM) considering demographic, clinical and oncological characteristics. Results: The median overall survival from HCC treatment was longer in patients with SVR than in those with active HCV infection both before (n = 2118: 61.0 months [95% confidence internal (CI): 56.5-65.5] vs. n = 1005: 51.0 months [95% CI: 43.4-58.6]; p = 0.003) and after PSM (n = 1285: 60.0 months [95% CI: 55.3-64.7] vs. n = 926: 54.0 months [95% CI: 46.7-61.3]; p = 0.030). Active HCV infection was associated with a greater risk of mortality (hazard ratio: 1.22-1.27, p = 0.001) independently of liver- and tumour-related variables, and modality of HCC treatment. Death due to liver failure was more common in patients with active HCV infection (24.5% vs. 17.1%; p = 0.001), while non-liver-related causes of death were more common in patients with SVR (25.0% vs. 17.0%; p = 0.001). Conclusions: SVR is associated with a better outcome in patients undergoing HCC treatment, thus suggesting that these patients may benefit from antiviral therapy for HCV independently of cure of HCC.