Kanwal F, et al. - In this retrospective cohort study, researchers assessed the long-term risk of hepatocellular cancer (HCC) in HCV patients treated with direct-acting antiviral agents (DAA). The study sample consisted of HCV patients who achieved SVR with DAA from 129 Veterans Health Administration hospitals between January 1, 2015, and December 31, 2015, with follow-up through September 30, 2018. Of 18,076 SVR patients, 544 HCC incident cases were diagnosed over a mean 2.9 years of follow-up. Data reported that the cumulative 1, 2 and 3-year risks of HCC were 1.1%, 1.9% and 2.8%, respectively. A strong association was found between cirrhosis and HCC risk. Findings revealed that HCC risk was the highest in patients who had persistently high FIB-4/APRI in both cirrhosis and non-cirrhosis patients. It was noted that most subjects treated at an early stage of liver fibrosis had a stable low risk. After 3.6 years of follow-up, patients successfully treated with DAA did not lower HCC risk. HCC risk in patients with cirrhosis stayed above the accepted thresholds for surveillance. In cured HCV patients, these data have significant implications for HCC surveillance.