l'Agence de recherche ANRS (France REcherche Nord&Sud Sida-HIV Hépatites), Paris, France.
J Hepatol. 2016 Oct;65(4):734-740. doi: 10.1016/j.jhep.2016.05.045. Epub 2016 Jun 7.
BACKGROUND & AIMS: Sustained virological response following interferon-based antiviral treatment of chronic hepatitis C is associated with decreased long-term risk of hepatocellular carcinoma (HCC) in advanced liver fibrosis. An unexpected high rate of HCC recurrence following antiviral treatment using direct-acting antiviral (DAA) has recently been reported.
We analyzed data individually from three French prospective multicentre ANRS cohorts including more than 6000 patients treated with DAA and we focused on HCC patients who underwent curative procedures before DAA treatment. The aim was to assess the rates of HCC recurrence in these patients according to antiviral treatment regimen.
In the ANRS CO22 "Therapeutic options for hepatitis B and C: a French cohort" (HEPATHER) cohort, 267 patients with chronic hepatitis C who were previously treated for HCC were analyzed, among whom 189 received DAA and 78 did not. The rates of recurrence were 0.73/100 and 0.66/100 person-months, respectively. In the ANRS CO12 "Cirrhose Virale" (CirVir) cohort, 79 cirrhotic patients in whom HCC was diagnosed and treated, 13 received DAA and 66 did not. The rates of recurrence were 1.11/100 and 1.73/100 person-months, respectively. In the ANRS CO23 "Compassionate use of Protease Inhibitors in viral C Liver Transplantation" (CUPILT) Cohort, 314 liver transplant recipients for HCC who were subsequently treated with DAA were analyzed. Seven HCC recurrences were reported after a median time of 70.3months after liver transplantation. The rate of recurrence was 2.2%.
In three distinct prospective cohorts, we did not observe an increased risk of HCC recurrence after DAA treatment, notably in patients who underwent curative HCC treatment including liver transplantation.
Since an unexpected high rate of hepatocellular carcinoma (HCC) recurrence after direct-acting antiviral (DAA) treatment has been suggested in a retrospective study, we analyzed data from three French prospective multicentre ANRS cohorts of >6000 DAA-treated patients who underwent curative HCC therapies. We did not observe an increased risk of HCC recurrence after DAA treatment: the rates of recurrence were similar in treated and untreated patients (0.73/100 and 0.66/100 person-months in in the ANRS CO22 HEPATHER cohort including 189 DAA+ and 78 DAA- and 1.11/100 in 13 DAA+ and 1.73/100 person-months in 66 DAA- in the ANRS CO12 CirVir cohort), respectively. Finally, in the ANRS CO23 CUPILT Cohort, HCC recurred in only 7 among 314 (2.2%) liver transplant recipients for HCC subsequently treated after 70months after liver transplantation.
慢性丙型肝炎患者经基于干扰素的抗病毒治疗后获得持续病毒学应答与晚期肝纤维化患者发生肝细胞癌（HCC）的长期风险降低相关。最近有报道称，使用直接作用抗病毒药物（DAA）进行抗病毒治疗后 HCC 复发率出乎意料地高。
我们分别分析了来自三个法国前瞻性多中心 ANRS 队列的超过 6000 例接受 DAA 治疗的患者的数据，重点关注在 DAA 治疗前接受根治性治疗的 HCC 患者。目的是根据抗病毒治疗方案评估这些患者的 HCC 复发率。
在 ANRS CO22“乙型肝炎和丙型肝炎的治疗选择：法国队列”（HEPATHER）队列中，分析了 267 例先前因 HCC 接受治疗的慢性丙型肝炎患者，其中 189 例接受了 DAA 治疗，78 例未接受。复发率分别为 0.73/100 和 0.66/100 人-月。在 ANRS CO12“病毒性肝硬化”（CirVir）队列中，分析了 79 例诊断和治疗 HCC 的肝硬化患者，其中 13 例接受了 DAA 治疗，66 例未接受。复发率分别为 1.11/100 和 1.73/100 人-月。在 ANRS CO23“病毒 C 肝移植中蛋白酶抑制剂的同情使用”（CUPILT）队列中，分析了 314 例因 HCC 接受肝移植后随后接受 DAA 治疗的肝移植受者。肝移植后中位时间 70.3 个月后报告了 7 例 HCC 复发。复发率为 2.2%。
在三个不同的前瞻性队列中，我们未观察到 DAA 治疗后 HCC 复发风险增加，尤其是在接受包括肝移植在内的根治性 HCC 治疗的患者中。
由于一项回顾性研究提示 DAA 治疗后肝细胞癌（HCC）复发率出乎意料地高，我们分析了三个法国前瞻性多中心 ANRS 队列的超过 6000 例接受 DAA 治疗的患者的数据，这些患者均接受了根治性 HCC 治疗。我们未观察到 DAA 治疗后 HCC 复发风险增加：治疗组和未治疗组的复发率相似（HEPATHER 队列中分别为 0.73/100 和 0.66/100 人-月，包括 189 例 DAA+和 78 例 DAA-，CirVir 队列中分别为 1.11/100 和 1.73/100 人-月，包括 13 例 DAA+和 66 例 DAA-）。最后，在 ANRS CO23 CUPILT 队列中，在接受肝移植治疗 HCC 后中位时间 70.3 个月后，仅 314 例（2.2%）肝移植受者中 7 例 HCC 复发。
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