Clinical Journal of Gastroenterology

, Volume 11, Issue 6, pp 497–500 | Cite as

Rapidly growing hepatocellular carcinoma recurrence during direct-acting antiviral treatment for chronic hepatitis C

  • Nobuyuki YamashitaEmail author
  • Hironori Tanimoto
  • Shinji Shimoda
  • Atsumasa Komori
  • Hideyuki Nomura
Case Report


We herein report the case of a woman in her 80s with a recurrent hepatocellular carcinoma (HCC) tumor that rapidly increased in size during direct-acting antiviral (DAA) treatment. She suffered from HCC at her initial visit to our department and underwent hepatectomy. Thereafter, she underwent DAA treatment for chronic hepatitis C; however, her alpha-fetoprotein (AFP) level rapidly increased, and a liver tumor of > 1 cm in diameter was observed that had not been seen immediately before DAA treatment. She underwent hepatectomy again and moderate to poorly differentiated HCC was diagnosed. The patient’s AFP level showed a rapid increase immediately after the start of DAA treatment; however, the increase ceased after the first month, and the influence from the surrounding environment of the tumor was considered to be temporary.


Direct-acting antivirals Hepatitis C virus Hepatocellular carcinoma Rapid increase Treatment 



We thank Assoc. Prof. Hidetaka Yamamoto of the Department of Anatomic Pathology, Pathological Science, Graduate School of Medical Sciences, Kyushu University (Fukuoka, Japan), for his pathological diagnosis, and Prof. Shinichi Aishima of the Departments of Pathology and Microbiology, Saga University Faculty of Medicine (Saga, Japan), for his advice.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from this patient for being included in this case report.


  1. 1.
    World Health Organization. Global hepatitis report 2017. Accessed 2 Feb 2018.
  2. 2.
    Ichida F, Tsuji T, Omata M, et al. New Inuyama classification: new criteria for histological assessment of chronic hepatits. Int Hepatol Commun. 1996;6:112–9.CrossRefGoogle Scholar
  3. 3.
    Reig M, Marino Z, Perello C, et al. Unexpected early tumor recurrence in patients with hepatitis C virus-related hepatocellular carcinoma undergoing interferon-free therapy: a note of caution. J Hepatol. 2016;65:719–26.CrossRefGoogle Scholar
  4. 4.
    Nagata H, Nakagawa M, Asahina Y, et al. Effect of interferon-based and -free therapy on early occurrence and recurrence of hepatocellular carcinoma in chronic hepatitis C. J Hepatol. 2017;67:933–9.CrossRefGoogle Scholar
  5. 5.
    Nakao Y, Hashimoto S, Abiru S, et al. Rapidly growing, moderately differentiated HCC: a clinicopathological characteristic of HCC occurrence after IFN-free DAA therapy? J Hepatol. 2018;68:854–55.CrossRefGoogle Scholar
  6. 6.
    Ogawa E, Furusyo N, Nomura H, et al. Short-term risk of hepatocellular carcinoma after hepatitis C virus eradication following direct-acting anti-viral treatment. Aliment Pharmacol Ther. 2018;47:104–13.CrossRefGoogle Scholar
  7. 7.
    Ikeda K, Kawamura Y, Kobayashi M, et al. Direct-acting antivirals decreased tumor recurrence after initial treatment of hepatitis C virus-related hepatocellular carcinoma. Dig Dis Sci. 2017;62:2932–42.CrossRefGoogle Scholar
  8. 8.
    Kanwal F, Kramer J, Asch SM, Chayanupatkul M, Cao Y, El-Serag HB. Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents. Gastroenterology. 2017;153:996–1005.e1.CrossRefGoogle Scholar
  9. 9.
    Waziry R, Hajarizadeh B, Grebely J, et al. Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: a systematic review, meta-analyses, and meta-regression. J Hepatol. 2017;67:1204–12.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Nobuyuki Yamashita
    • 1
    Email author
  • Hironori Tanimoto
    • 1
  • Shinji Shimoda
    • 2
  • Atsumasa Komori
    • 3
  • Hideyuki Nomura
    • 1
  1. 1.The Center for Liver DiseaseShin-Kokura HospitalFukuokaJapan
  2. 2.Medicine and Biosystemic Science, Graduate School of Medical ScienceKyushu UniversityFukuokaJapan
  3. 3.Clinical Research Center, National Hospital Organization (NHO) Nagasaki Medical CenterNagasaki University Graduate School of Biomedical SciencesNagasakiJapan

Personalised recommendations