{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:02:47Z","timestamp":1792587767120,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Hepatocellular carcinoma (HCC) accounts for 75\u201385% of primary liver malignancies, and elderlies have the highest incidence rates. Direct-acting antiviral agents (DAAs) have shown satisfying results in terms of HCV sustained viral response (SVR). However, data regarding HCC risk post-DAA-SVR is still conflicting. This study aims to consider HCC onset in moderate underlying liver disease. We conducted a retrospective study on 227 chronically infected patients (cHCV), treated with DAAs. Patients were divided into three groups: \u201cde novo occurrent HCC\u201d, \u201crecurrent HCC\u201d, and \u201cwithout HCC\u201d. Fifty-six patients aged &lt;65 years (yDAA) were studied separately. HCC patients aged \u226565 years (DAA-HCC) were compared to a historical group of 100 elderly HCC patients, treated with peginterferon (Peg-IFN) \u00b1 ribavirin antiviral agents, non-SVR (hHCC). The HCC prevalence in DAA patients was 32.75%: \u201cde novo occurrent\u2019\u2019 18.13% and \u201crecurrent\u2019\u2019 14.62%, despite 42.85% of them having no fibrosis to mild or moderate fibrosis (F0-F1-F2). yDAA showed 5.36% \u201cde novo occurrent\u201d HCC. Curative procedure rates were compared between DAA-HCC and hHCC at the first and at recurrent presentation (22 (39.29%) vs. 72 (72%); 17 (30.36%) vs. 70 (70%), respectively (p &lt; 0.001)). No significant difference was found in 3-year OS (p = 0.6). However, in cause-specific mortality analysis, HCC-related death was higher in the DAA-treated group, whereas cirrhosis-related death was more common in the historical group (p = 0.0288), considering together the two causes of death. A more accurate patient stratification according to multifactorial and new diagnostic investigations identifying HCC risk might allow an improvement in management and access to curative therapies.<\/jats:p>","DOI":"10.3390\/cancers13123025","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T04:15:46Z","timestamp":1623903346000},"page":"3025","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["HCC in the Era of Direct-Acting Antiviral Agents (DAAs): Surgical and Other Curative or Palliative Strategies in the Elderly"],"prefix":"10.3390","volume":"13","author":[{"given":"Stefania","family":"Brozzetti","sequence":"first","affiliation":[{"name":"Department of Surgery \u201cPietro Valdoni\u201d, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsia","family":"Tancredi","sequence":"additional","affiliation":[{"name":"Department of Surgery \u201cPietro Valdoni\u201d, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-4636","authenticated-orcid":false,"given":"Simone","family":"Bini","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"De Lucia","sequence":"additional","affiliation":[{"name":"Department of Surgery \u201cPietro Valdoni\u201d, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0035-0564","authenticated-orcid":false,"given":"Jessica","family":"Antimi","sequence":"additional","affiliation":[{"name":"Department of Surgery \u201cPietro Valdoni\u201d, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0165-7306","authenticated-orcid":false,"given":"Chiara","family":"D\u2019Alterio","sequence":"additional","affiliation":[{"name":"Department of Surgery \u201cPietro Valdoni\u201d, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Maria","family":"De Sanctis","sequence":"additional","affiliation":[{"name":"Department of Tropical and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Furlan","sequence":"additional","affiliation":[{"name":"Department of Tropical and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7377-4785","authenticated-orcid":false,"given":"Vittoria Carolina","family":"Malpassuti","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7448-1404","authenticated-orcid":false,"given":"Pierleone","family":"Lucatelli","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Di Martino","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Bezzi","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences Policlinico Umberto I, University of Rome La Sapienza, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ciardi","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological, Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7612-3646","authenticated-orcid":false,"given":"Rosa Maria","family":"Pascale","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgery and Experimental Sciences, Division of Experimental Pathology and Oncology, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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