Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
J Med Virol. 2017 Jan;89(1):153-160. doi: 10.1002/jmv.24595. Epub 2016 Jun 14.
Acute hepatitis C exacerbations can occur in cancer patients carrying hepatitis C virus (HCV) when receiving systemic chemotherapy. However, clinical studies evaluating these complications remain rare due to the lack of clinically proven effective and tolerable anti-HCV treatments at late cancer stages. Furthermore, no data were available regarding hepatitis C exacerbation in advanced hepatocellular carcinoma (HCC) patients receiving chemotherapy. To address this issue, 48 patients with HCV-related advanced HCC, who underwent systemic chemotherapy using 5- fluorouracil, cisplatin, and mitoxantrone from 2008 to 2014 were analyzed. Nine patients developed acute hepatitis exacerbations defined by HCV-RNA elevation ≥10-fold and alanine transaminase (ALT) elevation ≥5-fold of the upper normal limit. Six were genotype 1b and 3 were genotype 2. Three patterns of clinical courses were observed including single episode of exacerbation (n = 5), fluctuated flares (n = 3), and delayed exacerbation (n = 1). Hepatic failure developed in five patients. Patients with acute exacerbations were less likely to have pretreatment ascites (11.1% vs. 53.8%; P = 0.028) and displayed a lower baseline ALT (44.1 ± 28.5 U/L vs. 72.6 ± 19.2 U/L; P = 0.007). Paradoxically, despite a high risk of hepatic failure, occurrence of hepatitis C exacerbation was associated with a favorable overall survival (P = 0.027; 22.8 vs. 5.4 months). In conclusion, hepatitis C exacerbation can occur in HCC patients receiving chemotherapy, leading to liver failure. However, the flare was associated with a better overall survival, possibly due to its association with a better baseline liver function. J. Med. Virol. 89:153-160, 2017. © 2016 Wiley Periodicals, Inc.
丙型肝炎病毒（HCV）相关的晚期肝癌患者在接受化疗时可能会出现急性肝炎恶化。然而，由于在晚期癌症阶段缺乏经临床证实有效的、可耐受的抗 HCV 治疗方法，评估这些并发症的临床研究仍然很少。此外，对于接受化疗的晚期肝细胞癌（HCC）患者的 HCV 恶化，尚无数据可用。为了解决这个问题，分析了 2008 年至 2014 年间 48 例接受氟尿嘧啶、顺铂和米托蒽醌全身化疗的 HCV 相关晚期 HCC 患者。9 例患者的 HCV-RNA 升高≥10 倍，丙氨酸氨基转移酶（ALT）升高≥正常上限 5 倍，定义为急性肝炎恶化。其中 6 例为基因型 1b，3 例为基因型 2。观察到 3 种临床病程模式，包括单次恶化发作（n=5）、波动性发作（n=3）和延迟恶化（n=1）。5 例患者发生肝衰竭。急性恶化患者治疗前腹水较少（11.1% vs. 53.8%；P=0.028），基线 ALT 较低（44.1±28.5 U/L vs. 72.6±19.2 U/L；P=0.007）。矛盾的是，尽管发生肝衰竭的风险很高，但 HCV 恶化的发生与更好的总生存期相关（P=0.027；22.8 个月 vs. 5.4 个月）。总之，接受化疗的 HCC 患者可能会发生 HCV 恶化，导致肝衰竭。然而，肝炎恶化与更好的总生存期相关，可能是因为其与更好的基线肝功能相关。J. Med. Virol. 89:153-160, 2017. © 2016 Wiley Periodicals, Inc.
