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We evaluated the impact of treatment status on risk of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> using data from the Chronic Hepatitis Cohort Study (<jats:styled-content style=\"fixed-case\">CH<\/jats:styled-content>e<jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\u2013an observational study based in four large <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> health systems, with up to 7 years of follow\u2010up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 <jats:styled-content style=\"fixed-case\">HCV<\/jats:styled-content> patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (<jats:styled-content style=\"fixed-case\">TF<\/jats:styled-content>), and 1582 (43%) of these achieved sustained virological response (<jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content>). <jats:styled-content style=\"fixed-case\">TF<\/jats:styled-content> patients demonstrated almost twice the risk of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> than untreated patients [adjusted hazard ratio (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content>) = 1.95, 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 1.50\u20132.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> and all\u2010cause mortality compared to White patients. <jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content> patients had lower risk of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> than <jats:styled-content style=\"fixed-case\">TF<\/jats:styled-content> patients (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> = 0.48, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.31\u20130.73), whereas treatment \u2013 regardless of outcome \u2013 reduced all\u2010cause mortality (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> = 0.45, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.34\u20130.60 for <jats:styled-content style=\"fixed-case\">SVR<\/jats:styled-content> patients; <jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> = 0.78, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.65\u20130.93 for <jats:styled-content style=\"fixed-case\">TF<\/jats:styled-content> patients).<\/jats:p>","DOI":"10.1111\/jvh.12538","type":"journal-article","created":{"date-parts":[[2016,3,31]],"date-time":"2016-03-31T16:56:47Z","timestamp":1459443407000},"page":"718-729","source":"Crossref","is-referenced-by-count":30,"title":["Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma"],"prefix":"10.1111","volume":"23","author":[{"given":"Mei","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Health System Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Health System Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loralee B.","family":"Rupp","sequence":"additional","affiliation":[{"name":"Center for Health Policy and Health Services Research Henry Ford Health System Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott D.","family":"Holmberg","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne C.","family":"Moorman","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip R.","family":"Spradling","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyasu H.","family":"Teshale","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueren","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Health System Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph A.","family":"Boscarino","sequence":"additional","affiliation":[{"name":"Center for Health Research Geisinger Health System Danville PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark 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