الفهرس 
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Abstract
HCC is the sixth most common malignancy and the third most common cause of cancer related death worldwide.
Cirrhosis is the strongest risk factor for HCC, and chronic hepatitis C (HCV) is the most common underlying etiology in Egypt, United States and Europe.
The annual risk of developing HCC in HCV-related cirrhotic patients is approximately 2%-8%.
The new, highly effective DAAs were expected to dramatically decrease HCV‐related liver disease progression to end-stage liver disease and HCC; however, these optimistic expectations were questioned by many reports to illustrate the link between DAAs and possibility of occurrence or recurrence of HCC.
Recent studies have suggested that DAA may accelerate the occurrence of HCC in patients with liver cirrhosis. However, the annual risk of HCC in HCV-related cirrhotic patients is approximately 2%-8%. Ultimately, the results of these studies did not show an increased risk of HCC in comparison to the expected annual risk for patients treated with DAAs.
The Aim of the study was to compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn’t receive DAAs
The study was conducted on patients with de novo HCC presented at HCC Clinic and Tropical medicine department at Ain Shams University Hospitals between December 2017 and December 2018, aged (18-70 years old). Total number of HCC cases visited the HCC clinic was 416 patients. 160 patients with denovo HCC were enrolled in the study according to inclusion criteria and devided to two groups:
group (A): included 80 patients with de novo HCC that received DAAs; 59 males (73.8%),21 females (26.3%) with mean age of (61.85%).
group (B): included 80 patients with de novo HCC that didn’t receive DAAs treatment before; 22 females (27.5%), 58 males (72.5%) with a mean age of (59.28%) years.
The two groups were compared according to demographic data, signs of decompensation, child pugh score, MELD score, BCLC stages and Tumor burden.
There was no statistical significant difference between two groups regarding demographic data except for Age (P= 0.01).
Otherwise there was a significant difference regarding bilharziasis and IV anti bilhariziasis therapy, in group (A) 17 patients(21.3%) had a previous history of bilharziasis, while in group (B) only 5 patients (6.3%) had bilharziasis with P= 0.01.
There was no significant difference between the two studied groups regarding laboratory value except for AST,ALT (P<0.001), INR (P=0.04)
Unlike some previous concerns about increased biologic aggressiveness of HCC after DAA treatment, resulting in infiltrative pattern and multinodular tumors outside Milan criteria, the results of our study on de novo HCC after DAAs were mostly single, small, and diagnosed in early stages, resulting in BCLC stage 0-B in the majority of patients. Also, we found no statistical significant difference between the 2 groups as regard sex, history of DM or Hypertension.
In our study we found there was no difference in tumor aggressiveness between patients with de novo HCC following DAA and patients with HCC that didn’t receive DAA regarding number of HFLs, total size of HFLs, malignant vascular invasion, suspicious malignant lymphadenopathy or extrahepatic metastasis HCC.
There were no differences regarding total size of tumor, or difference in vascular invasion, but there’s a difference in largest size of HFLs that was more significant in group (A)
Patients of group (A) with that received DAA showed lower child pugh score than those HCC of group (B) that didn’t treated with DAAs.
The Current study revealed 70 patients (87.5%) of group A achieved SVR with DAAs. there was no significant statistical value between both groups as regard type of intervention and type of DAAs that received as well as between type of DAAs and survival with(P =0.71).
There was no statistical significant difference between the 2 groups as regard type of of interventions that patients were eligible for.
There was no significant difference between 2 groups regarding survival of patients.