Carmen Monica Preda, Hitomi Sezaki, John S Lubel, Fabien Zoulim, Dong Hyun Lee, Zongfang Li, Yasuhito Tanaka, Akihiro Tamori, Tatsuya Ide, Mindie H. Nguyen, Jean-François Dufour, Yee Hui Yeo, Michelle B. Bass, Dennis Eurich, Victor Virlogeux, Linda Henry, Shuangsuo Dang, Mike T. Wei, Philippe Kolly, Bin Wei, Pietro Andreone, Wenjun Wang, Po-sung Chu, Masaru Enomoto, Tatsuya Minami, Etsuko Iio, Rob Bielen, Ramsey Cheung, Fabio Conti, Hidenori Toyoda, Eiichi Ogawa, Norihiro Furusyo, Michele Barone, Fanpu Ji, Takanori Kanai, Ji F., Yeo Y.H., Wei M.T., Ogawa E., Enomoto M., Lee D.H., Iio E., Lubel J., Wang W., Wei B., Ide T., Preda C.M., Conti F., Minami T., Bielen R., Sezaki H., Barone M., Kolly P., Chu P.-S., Virlogeux V., Eurich D., Henry L., Bass M.B., Kanai T., Dang S., Li Z., Dufour J.-F., Zoulim F., Andreone P., Cheung R.C., Tanaka Y., Furusyo N., Toyoda H., Tamori A., and Nguyen M.H.
Background & Aims: The effect of hepatocellular carcinoma (HCC) on the response to interferon-free direct-acting antiviral (DAA) therapy in patients with chronic hepatitis C (CHC) infection remains unclear. Using a systematic review and meta-analysis approach, we aimed to investigate the effect of DAA therapy on sustained virologic response (SVR) among patients with CHC and either active, inactive or no HCC. Methods: PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from 1/1/2013 to 9/24/2018. The pooled SVR rates were computed using DerSimonian-Laird random-effects models. Results: We included 49 studies from 15 countries, comprised of 3,341 patients with HCC and 35,701 without HCC. Overall, the pooled SVR was lower in patients with HCC than in those without HCC (89.6%, 95% CI 86.8–92.1%, I2 = 79.1% vs. 93.3%, 95% CI 91.9–94.7%, I2 = 95.0%, p = 0.0012), translating to a 4.8% (95% CI 0.2–7.4%) SVR reduction by meta-regression analysis. The largest SVR reduction (18.8%) occurred in patients with active/residual HCC vs. inactive/ablated HCC (SVR 73.1% vs. 92.6%, p = 0.002). Meanwhile, patients with HCC who received a prior liver transplant had higher SVR rates than those who did not (p