Med. Surg. J. – Rev. Med. Chir. Soc. Med. Nat., Iaşi 2021, 125(1): 48-53 doi: 10.22551/MSJ.2021.01.07 INTERNAL MEDICINE - PEDIATRICS ORIGINAL PAPERS 48 NO EVIDENCE OF A MORE AGGRESSIVE PATTERN OF HEPATOCELLULAR CARCINOMA AFTER DIRECT ACTING ANTIVI- RALS -RESULTS FROM A SINGLE CENTER OBSERVATIONAL STUDY Cristina-Maria Muzica 1,2 , Anca Trifan 1,2* , Irina Gîrleanu 1,2 , Laura Huiban 1,2 , Oana Cristina Petrea 1,2 , Ana Maria Sîngeap 1,2 , Camelia Cojocariu 1,2 , S. Zenovia 1,2 , T. Cuciureanu 1,2 , R. Nastasa 1,2 , C. Stanciu 1,2 “Grigore T. Popa” University of Medicine and Pharmacy Iasi , Romania Faculty of Medicine 1. Department of Medical Specialties (I) “Sf. Spiridon” County Clinical Emergency Hospital Ia si, Romania 2. Institute of Gastroenterology and Hepatology * Corresponding author. E-mail: ancatrifan@yahoo.com NO EVIDENCE OF A MORE AGGRESSIVE PATTERN OF HEPATOCELLULAR CAR- CINOMA AFTER DIRECT ACTING ANTIVIRALS-RESULTS FROM A SINGLE CEN- TER OBSERVATIONAL STUDY (Abstract): After great concerns were raised regarding a high incidence of hepatocellular carcinoma (HCC) after direct acting antivirals (DAAs) ther- apy in cirrhotic HCV patients, an avalanche of studies that debated this issue emerged, whose results highlighted also a more aggressive HCC pattern after DAAs. We aimed to as- sess the pattern and imaging features of HCC in patients with HCV-related liver cirrhosis af- ter DAAs. Material and methods: This is a single-center case-controlled retrospective study in which we included consecutive patients with HCC and HCV-related liver cirrhosis admitted in our clinic between January 1 st , 2016 and May 1 st , 2018. Results: Sixty-nine pa- tients with HCV-related cirrhosis and HCC were divided into 2 groups depending on the DAAs-treated or untreated status: group I included 15 patients that were previously treated with DAAs and group II included 54 naïve patients. Regarding the distribution of HCC, there were no significant differences between the two groups (73.3% of group I patients and 55.5% of group II had unicentric lesion, p=0.215). The tumor size was significantly higher in group II compared to group I, with 66.6% of patients in group I and only 29.6% of patients in group II that have a tumor size less than 3 cm (p=0.009). Supportive treatment without ab- lation was more frequent in group II (33.3%) than in group I (6.6%) (p=0.047). Conclu- sions: Our study found no evidence of a more aggressive behavior of HCC after DAAs treatment compared to naïve patients. Furthermore, the pattern of HCC after DAAs did not affect the access to curative treatment. Keywords: HEPATOCELLULAR CARCINOMA, DIRECT ACTING ANTI-VIRALS, AGGRESSIVE PATTERN. Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy ranked as the second leading cause of can- cer-related death, with increasing incidence rates worldwide (1). The developments from the past 10 years considerably im- proved the therapeutic management of HCC leading to extended access to thera-