The unexpected high risk of occurrence or recurrence of hepatocellular carcinoma after successful antiviral therapy with interferon-free direct-acting antivirals

Chronic hepatitis C (CHC) infection is one of the major etiologies of hepatocellular carcinoma (HCC). In the previous era of interferon-based therapy, successful viral eradication has greatly reduced the risk of disease progression and HCC occurrence (1-3). Around three quarters of HCC events may be prevented at all stages of liver fibrosis (1,4,5), even among patients with compensated liver cirrhosis (6). On the hand, the effect of interferon-based antiviral therapy in tertiary prevention of HCC recurrence is much more controversial (7-11), which may attribute to heterogeneous patient characteristics and study designs.