Volume 155, Issue 5, Pages 1436-1450.e6 (November 2018) Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs  Pierre Nahon, Richard Layese, Valérie Bourcier, Carole Cagnot, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean-Pierre Bronowicki, Jean-Pierre Zarski, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen-Khac, Brigitte Bernard-Chabert, David Zucman, Vincent Di Martino, Angela Sutton, Françoise Roudot-Thoraval, Etienne Audureau Pierre Nahon, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Hélène Fontaine, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean-Pierre Bronowicki, Jean-Pierre Zarski, Vincent Leroy, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Sebastien Dharancy, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen-Khac, Brigitte Bernard-Chabert, Sophie Hillaire, Vincent Di Martino Pierre Nahon, Richard Layese, Valérie Bourcier, Carole Cagnot, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean-Pierre Bronowicki, Jean-Pierre Zarski, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen-Khac, Brigitte Bernard-Chabert, David Zucman, Vincent Di Martino, Angela Sutton, Françoise Roudot-Thoraval, Etienne Audureau Pierre Nahon, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Hélène Fontaine, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean-Pierre Bronowicki, Jean-Pierre Zarski, Vincent Leroy, Ghassan Riachi, Paul Calès, Jean-Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Sebastien Dharancy, Jean-Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean-Didier Grangé, Pierre Attali, Yannick Bacq, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen-Khac, Brigitte Bernard-Chabert, Sophie Hillaire, Vincent Di Martino  Gastroenterology  Volume 155, Issue 5, Pages 1436-1450.e6 (November 2018) DOI: 10.1053/j.gastro.2018.07.015 Copyright © 2018 AGA Institute Terms and Conditions

Figure 1 Crude incidence of HCC as a function of antiviral therapy. Patients receiving DAAs had a lower HCC incidence when compared with non-SVR patients but a higher incidence vs patients who achieved an SVR following an IFN-based regimen. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Figure 2 Incidence of liver decompensation and deaths as a function of antiviral therapy. (A) Patients treated with DAAs or who achieved an SVR following IFN-based therapy had lower incidences of liver decompensation when compared with non-SVR patients. (B) DAA patients had intermediate survival rates when compared with non-SVR patients and patients who achieved an SVR following IFN-based therapy. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Figure 3 Incidence of HCC as a function of DAA treatment using IPTCW. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 1 Flow chart of the studied population. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 2 Incidence of non-HCC hepatic focal lesions according to treatment allocation. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 3 Crude HCC incidence in patients with HCV genotype 1 according to first- or second-generation DAAs intake. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 4 Crude incidence of HCC as a function of SVR status in DAA patients. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 5 HCC rates in patients ultimately taking DAAs during follow-up. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 6 Crude incidence of HCC in DAA patients as a function of treatment regimen. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 7 Extrahepatic events as a function of antiviral therapy. (A) Patients treated with DAAs or who achieved an SVR following IFN-based therapy had lower incidences of cardiovascular events (B) Patients treated with DAAs or who achieved an SVR following IFN-based therapy had lower incidences of extrahepatic cancers. (C) DAA patients had the lowest incidence of BI when compared with patients treated with IFN-based therapy (with or without SVR). Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 8 HCC crude incidence in patients who never experienced liver decompensation before treatment initiation. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions

Supplementary Figure 9 Crude HCC incidence in DAA patients according to the last screening examination before treatment initiation. Among the 336 DAA patients, 168 (50.0%) had been screened within 6 months before DAA initiation without any detected nodule (group 1). Group 2 comprised patients with at least 1 focal lesion detected before DAAs initiation or who underwent screening procedure more than 7 months before DAAs initiation. Patients who had an inappropriate screening interval or had been detected with a liver focal lesion had a higher HCC incidence. Gastroenterology 2018 155, 1436-1450.e6DOI: (10.1053/j.gastro.2018.07.015) Copyright © 2018 AGA Institute Terms and Conditions