الفهرس 
Epidemiology and SurveillanceOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related death worldwide. Whereas in Egypt, it represents the most commonly diagnosed cancer, with about 27,895 new cases in 2020. Notably, HCV represents a major cause of HCC and Egypt had the highest prevalence of HCV infection.
With the introduction of the DAA agents in 2014 as an effective HCV treatment, the National Committee for Control of Viral Hepatitis (NCCVH) started a national program to make HCV treatment available for all and covered by the Egyptian government, therefore, by 2018 40% of the total HCV-infected population were treated about more than 2 million patients, with SVR rate above 90%. This in line with the WHO global hepatitis strategy to eradicate viral hepatitis by 2030.
Chronic HCV patients with prior history of HCC was a challenging situation in HCV treatment, our NCCVH recommended to receive DAA after more than 4 weeks of HCC treatment and achieving rCR. However, there is a constant controversy about is DAA therapy increase HCC recurrence in patients with history of HCC; some studies were agreed with this hypothesis, while others were against.
Therefore, we conducted this study trying to solve this dilemma by prospectively randomize chronic HCV infected patients with prior history of HCC and achieving rCR either to receive DAA or not, also we do second randomization in DAA-treated arm based on the time interval from HCC treatment and DAA therapy with cut-off point at 6 months.
Our study showed no difference in HCC recurrence and OS between DAA treated and non-treated HCV patients with prior history of HCC and achieving rCR. SVR after DAA therapy was significantly correlated with lower HCC RR and longer OS. A post-hoc subgroup analysis detected a trend of lower HCC recurrence and better survival in patients who received DAA after at least 12 months of HCC treatment, however this data is hypothesis generating needs to be confirmed by subsequent prospective multicentric trial.