Cabibbo G, et al. – This prospective multicentre study aimed to evaluate the risk of hepatocellular carcinoma (HCC) early recurrence after direct–acting antivirals (DAAs) exposure in a large prospective cohort of HCV–cirrhotic patients with previous successfully treated HCC. It also determined the risk factors for early recurrence. Despite HCV eradication by DAAs, the probability of HCC early recurrence in patients who had HCC previously cured remained high. The risk was similar but not higher to that reported in the literature in DAA–untreated patients. To stratify the risk of HCC early recurrence, previous HCC recurrence and tumour size could be used. To evaluate the effect of DAAs on late recurrence and mortality, further studies were needed.

• For this study, the physicians recruited 143 consecutive patients with complete response after curative treatment of HCC, subsequently treated with DAAs and monitored by the web-based RESIST-HCV database.
• They collected clinical, biological, and virological data.
• The probability of HCC early recurrence from DAA starting by Kaplan-Meier method was the primary endpoint.

• In this study, 86% of patients were in Child-Pugh class A and 76% of patients were BCLC A.
• Nearly all patients (96%) achieved sustained virological response.
• The physicians observed 24 HCC recurrences, with nodular or infiltrative pattern in 83% and 17% of patients, respectively.
• 12%, 26.6% and 29.1% were the 6-, 12- and 18-month HCC recurrence rates, respectively.
• By Cox multivariate model, independent risk factors for HCC recurrence were main tumour size and history of prior HCC recurrence.