Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
Department of Digestive Diseases, Policlinico S.Orsola-Malpighi, Bologna, Italy.
J Hepatol. 2016 Oct;65(4):727-733. doi: 10.1016/j.jhep.2016.06.015. Epub 2016 Jun 24.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) represents a serious complication of HCV-related cirrhosis. New direct-acting antivirals (DAA) cure HCV infection in over 90% of patients. The aim of this study was to evaluate the early occurrence and recurrence of HCC in cirrhotic patients treated with DAA.
We analysed 344 consecutive cirrhotic patients, without HCC, who were treated with DAA, and followed for 24weeks. Fifty-nine patients had previous HCC.
DAA therapy induced sustained virological response in 91% of patients. During 24-week follow-up, HCC was detected in 26 patients (7.6%, 95% CI: 4.99-10.84): 17 of 59 patients (28.81%, 95% CI: 17.76-42.07) with previous HCC and 9 of 285 patients (3.16%, 95% CI: 1.45-5.90) without previous HCC. Child-Pugh Class B, more severe liver fibrosis, lower platelet count, and previous HCC were significantly associated with HCC development, at univariate analysis. At multivariate analysis, Child-Pugh class (p=0.03, OR: 4.18, 95% CI: 1.17-14.8) and history of HCC (p<0.0001, OR: 12.0, 95% CI: 4.02-35.74) resulted independently associated with HCC development. Among the 59 patients with previous HCC, younger age and more severe liver fibrosis were significantly associated with HCC recurrence, both at univariate and at multivariate analysis.
In patients with HCV-related cirrhosis, DAA-induced resolution of HCV infection does not seem to reduce occurrence of HCC, and patients previously treated for HCC have still a high risk of tumour recurrence, in the short term. For these reasons, all cirrhotic patients should be closely monitored and followed during and after antiviral therapy.
New direct-acting antivirals are able to eradicate HCV infection in over 90% of patients with advanced liver disease. Unfortunately, the occurrence of liver cancer is not reduced in effectively treated cirrhotic patients. In addition, patients previously treated for HCC have still a high risk of tumour recurrence in the short term, despite DAA treatment.
肝细胞癌（HCC）是丙型肝炎相关肝硬化的严重并发症。新型直接作用抗病毒药物（DAA）能治愈超过 90%的丙型肝炎病毒感染者。本研究旨在评估 DAA 治疗的肝硬化患者中 HCC 的早期发生和复发情况。
我们分析了 344 例连续的无 HCC 的肝硬化 DAA 治疗患者，并进行了 24 周的随访。59 例患者有 HCC 病史。
DAA 治疗使 91%的患者获得持续病毒学应答。在 24 周的随访期间，26 例患者（7.6%，95%CI：4.99-10.84）检测到 HCC：59 例 HCC 病史患者中 17 例（28.81%，95%CI：17.76-42.07），285 例无 HCC 病史患者中 9 例（3.16%，95%CI：1.45-5.90）。Child-Pugh 分级 B、更严重的肝纤维化、较低的血小板计数和 HCC 病史在单因素分析中与 HCC 发展显著相关。多因素分析显示，Child-Pugh 分级（p=0.03，OR：4.18，95%CI：1.17-14.8）和 HCC 病史（p<0.0001，OR：12.0，95%CI：4.02-35.74）是 HCC 发展的独立相关因素。在 59 例有 HCC 病史的患者中，年龄较小和更严重的肝纤维化在单因素和多因素分析中均与 HCC 复发显著相关。
在丙型肝炎相关肝硬化患者中，DAA 诱导的 HCV 感染清除似乎并未降低 HCC 的发生，而先前接受 HCC 治疗的患者在短期内仍有很高的肿瘤复发风险。因此，所有肝硬化患者在抗病毒治疗期间和之后都应密切监测和随访。
