Hi Gaj, thanks for your efforts about clarification of such things. Possibly, some waiting for more confident data may be an appropriate decision for many people with compensated cirrhosis.

I agree with most of your doubts about confidence in study’s statistics. Really, group is quite small, and HCC incidence may vary according to disease severity, age… Probably, HCC rate in group of young compensated cirrhotics will be lower than in group of old sub/decompensated cirrhotics. There are many people with child B cirrhosis in group – it is unlikely that such people are interferon eligible. Hence, interferon-treated group, in average, is more helathy than DAA treated group – such difference may affects HCC rate. Five of the nineteen relapsed, probably, is not an issue, because they are “subgroup with HCC” of full cohort. Real SVR rate in full cohort may be much higher.

Another small study – http://dx.doi.org.sci-hub.cc/10.1016/j.jhep.2016.07.027 – “High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis” 4 HCC ocurrence per 54 patients – 7.4% rate. 7.4% rate is quite high – 1:13 chance. Nearly 30% of HCC recurrence rate from other studies seems extremely high… From the other side, some studies do not show increased HCC rate – http://www.natap.org/2016/EASL/EASL_76.htm Results of studies seem contradictory – probably, time will tell…

Hi beaches,

of course, patients with cirrhosis have some risk of HCC (several percents per year)… But main question – whether treatment is worse than disease or not… Sofosbuvir was approved in 2013 – and many people was treated with DAAs during 2013-2016 (and earlier, in clinical trials). Hope that retrospective studies are possible to determine HCC risk after DAA treatment.

most people with HCV develop cirrhosis and HCCs.

If i correctly understand, from point of view of current medical evidence this is not correct. “The majority of patients with chronic HCV infection are fortunate not to develop cirrhosis and the need for liver transplantation” (http://www.journal-of-hepatology.eu/article/S0168-8278(13)00598-9/fulltext ) In some studies, there are such data that only 20% (or something like that) of HCV-infected will develop decompensated cirhhosis and/or HCC during lifetime without treatment. Really, we dont know this percent with 100% certainty – because this requires very long observation (lifetime long), and virus was discovered only several decades ago. Also, there are many contributing factors which affects fibrosis progression – alcohol consumption, body weight…

Hi Serg,

This thread was initially mostly a warning about a potential increased risk of HCC recurrence for those who had a previous history of HCC but you seem to be trying to extrapolate that to show that

…You seem to believe there is a significant risk for all cirrhosis patients taking DAAs and using that to justify not commencing treatment. You should remember that when looking at any risks associated with a disease and its treatment we need to ensure we look at the big picture rather than just focussing on one particular aspect to the exclusion of all others.

While HCC rate in the study graph you link is 6.6% for the first 12 months, in the following 12 months it drops to 1.9% (and still falling) and that needs to be compared with the ongoing annual rate without treatment. If you go back and look at Dr James initial post in this thread he says –

Now you should note that the annual rate of developing HCC in cirrhotic patients is 2-6% so that 3% is essentially what you would expect with OR without treatment. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840947/

So 6.6% dropping to 1.9% may indicate an increased initial risk followed by a rapid decline….or it may just be within the normal spread of statistical data over any period of time.

Then have a look at the graph marked DC below that one which shows a large and continuing decrease in the rates of liver decompensation for this same group of patients. That correlates well with our overall knowledge about how removing the antagonist of cirrhosis results in a reduction in its progression in line with the comments here https://fixhepc.com/forum/experts-corner/923-daas-and-liver-cancer-risk.html?start=30#20388

As medical research progresses we learn more but there will never be a stage where we know everything. With that in mind we all need to look at our individual situations and take the best medical advice currently available to us and then weigh up whether we treat now or wait. But at some point we do need to make a decision and with that in mind perhaps a reread of the below link may assist?

https://fixhepc.com/forum/experts-corner/320-why-am-i-afraid-to-take-the-medications.html#2770

My comment was just a lead in to my thoughts and not intended to imply you shouldn’t be discussing it in this thread. I have struck out that part.

Are you “well” compensated or decompensated as are those in the last study you are now citing? If the first my comments about reduced risk of decompensation still apply. But the study is looking at patients who are already decompensated and have compromised livers to start with. In that cohort a subgroup with certain criteria such as older than 65 and albumin less than 35 were found to be more likely to see an increase in MELD score under treatment. That is not entirely unexpected in a group who are seriously ill to begin with…..but it is a different argument to HCC occurrence.

Serg – I truly hope you can find solace between hell and the deep blue sea. Statistics are made from either indecision or over a analyzing, may you find your way and then be persistent in it. I always said a decision must be made even if it is wrong, I made it and I’ll deal with it.
In good health to you my friend.

Sven, thank you. Of course, nobody wants to suffer, and everyone wants to be healthy and happy. My decision is some waiting for additional data now, treatment with cirrhosis looks like “game with high stakes” – thus, I want to be confident about possible risks.
I wish you health and good luck with your treatment!

Hey Serg, you have forgotten to add your path details to your signature.