Abstract: Objective To investigate the clinical characteristics of hepatitis C (HCV) associated hepatocellular carcinoma (HCC) and the effect of antiviral therapy on the prognosis of HCC.Methods The clinical data of 115 patients with HCV-related HCC hospitalized in our hospital from January 2011 to December 2020 were retrospectively analyzed. The patients were divided into untreated group (UCHC), treatment failure group (TF) and sustained virologic response group (SVR) according to antiviral treatment. The clinical characteristics and the effect of direct antiviral agent (DAA) on prognosis of the 3 groups were compared.Results Among 115 patients, 72 (62.6%) were male and 43 (37.4%) were female. The age ranged from 36 to 84 years old (62.6±7.1). The main route of transmission was blood transfusion or related blood products (57.4%), followed by drug use (11.3%). Genotype 1 59.1%, genotype 2 14.8%, genotype 3 14.8%, genotype 6 5.2%, 6.1% undetected. There was no significant difference in age, gender, blood transfusion history, genotype 1, white blood cell (WBC) count, hemoglobin (Hb) and total bilirubin (TBil) levels among the 3 groups at the time of HCC (P > 0.05). The proportion of cirrhosis decompensation, proportion of HBsAg negative and anti-HBc-IgG positive patients, alanine transaminase (ALT), aspartate transaminase (AST) and alpha fetoprotein (AFP) levels in SVR group were lower than those in TF group and UCHC group, with statistical significance (P<0.05). The levels of platelet (PLT), albumin (Alb) and epidermal growth factor receptor (eGFR) in SVR group were higher than those in TF group and UCHC group, with statistical significance (P<0.05). The incidence of portal vein cancer thrombus was 18.9% in SVR group, which was significantly lower than 36.4% in TF group and 30.4% in UCHC group (P<0.01). During the 2-year follow-up, the disease progression in SVR group was 10.3%, which was significantly lower than that in TF group (54.5%) and UCHC group (43.5%), with statistical significance (P<0.001). Further analysis showed that the disease progression rates within 9 months of patients who completed DAA treatment in TF group and UCHC group were 42.9% and 20.0%, significantly lower than those of patients who did not use DAA (75.0% and 61.5%), with statistical significance (P<0.01). The 2-year mortality in SVR group was 6.9%, which was lower than that in TF group and UCHC group (36.4% and 17.4%, P<0.05).Conclusion This study suggests that it is necessary for patients with HCV-associated HCC to get DAA antiviral therapy, which is helpful to improve the therapeutic effect, as well as reduce the metastasis and deterioration of HCC.

Key words: Chronic hepatitis C, Hepatocellular carcinoma, Direct antiviral agent, Sustained virological response, Prognosis