Strazzulla Alessio, Iemmolo Rosa Maria Rita, Carbone Ennio, Postorino Maria Concetta, Mazzitelli Maria, De Santis Mario, Di Benedetto Fabrizio, Cristiani Costanza Maria, Costa Chiara, Pisani Vincenzo, Torti Carlo
Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy.
Hepat Mon. 2016 Oct 30;16(11):e41933. doi: 10.5812/hepatmon.41933. eCollection 2016 Nov.
Since directly acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) were introduced, conflicting data emerged about the risk of hepatocellular carcinoma (HCC) after interferon (IFN)-free treatments. We present a case of recurrent, extra-hepatic HCC in a liver-transplanted patient soon after successful treatment with DAAs, along with a short review of literature.
In 2010, a 53-year old man, affected by chronic HCV (genotype 1) infection and decompensated cirrhosis, underwent liver resection for HCC and subsequently received orthotopic liver transplantation. Then, HCV relapsed and, in 2013, he was treated with pegylated-IFN plus ribavirin; but response was null. In 2014, he was treated with daclatasvir plus simeprevir to reach sustained virological response. At baseline and at the end of HCV treatment, computed tomography (CT) scan of abdomen excluded any lesions suspected for HCC. However, alpha-fetoprotein was 2.9 ng/mL before DAAs, increasing up to 183.1 ng/mL at week-24 of follow-up after the completion of therapy. Therefore, CT scan of abdomen was performed again, showing two splenic HCC lesions.
Overall, nine studies have been published about the risk of HCC after DAAs. Patients with previous HCC should be carefully investigated to confirm complete HCC remission before starting, and proactive follow-up should be performed after DAA treatment.
自从用于治疗丙型肝炎病毒（HCV）的直接抗病毒药物（DAA）问世以来，关于无干扰素治疗后肝细胞癌（HCC）风险的数据出现了矛盾。我们报告一例肝移植患者在成功接受DAA治疗后不久出现复发性肝外HCC的病例，并对相关文献进行简要综述。
2010年，一名53岁男性，患有慢性HCV（1型）感染和失代偿性肝硬化，因HCC接受肝切除术，随后接受原位肝移植。之后，HCV复发，2013年，他接受聚乙二醇化干扰素联合利巴韦林治疗，但无反应。2014年，他接受达卡他韦联合simeprevir治疗以达到持续病毒学应答。在HCV治疗基线期和结束时，腹部计算机断层扫描（CT）排除了任何疑似HCC的病变。然而，在使用DAA之前甲胎蛋白为2.9 ng/mL，治疗完成后随访第24周时升至183.1 ng/mL。因此，再次进行腹部CT扫描，显示脾脏有两个HCC病变。
总体而言，已发表了九项关于DAA治疗后HCC风险的研究。既往有HCC的患者在开始治疗前应仔细检查以确认HCC完全缓解，并且在DAA治疗后应进行积极随访。
