Lee Seung Ho, Jin Young-Joo, Shin Jun Young, Lee Jin-Woo
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
Medicine (Baltimore). 2017 Jan;96(1):e5321. doi: 10.1097/MD.0000000000005321.
In this new era of highly effective oral antiviral drugs for chronic hepatitis C virus (HCV), indications for antiviral treatment may be extendable. This study undertaken to identify suitable candidates for peg-interferon plus ribavirin (PEG-IFN/RBV) treatment by evaluating hepatocellular carcinoma (HCC) risk in patients with chronic HCV treated or not with PEG-IFN/RBV.This large-scale retrospective study was conducted on 1176 patients with chronic HCV without a history of HCC (treatment group [n = 489] and no-treatment group [n = 687]). In the treatment group, patients treated with PEG-IFN/RBV were dichotomized based on the achievement of sustained virologic response (SVR) into SVR (+) and SVR (-) groups.Median follow-up for all study subjects was 31 months (range 6-144 months). Three-year cumulative HCC development rates in the SVR (+) (1.1%) and SVR (-) (8.6%) subgroups were significantly lower than in the no-treatment group (13.5%) (P < 0.01 and P < 0.01, respectively). In all study subjects, presence of cirrhosis (hazard ratio [HR], 9.92, P < 0.01), age (HR 1.03, P < 0.01), SVR (-) (HR 7.02, P < 0.01), and no-treatment (HR 6.76, P < 0.01) were found to be independent risk factors of HCC development. In the treatment group, age, the presence of cirrhosis, and SVR (-) were predictors of HCC development. In the no-treatment group, age, male, and the presence of cirrhosis were independent predictors for HCC development.HCC risk increased in patients with chronic HCV with older age, cirrhosis, SVR (-) after PEG-IFN/RBV treatment, and no PEG-IFN/RBV treatment. Active antiviral therapy based on highly effective oral drugs needs to be considered in these patients.
在慢性丙型肝炎病毒（HCV）有高效口服抗病毒药物的新时代，抗病毒治疗的适应证可能会扩大。本研究旨在通过评估接受或未接受聚乙二醇干扰素加利巴韦林（PEG-IFN/RBV）治疗的慢性HCV患者的肝细胞癌（HCC）风险，来确定适合PEG-IFN/RBV治疗的患者。这项大规模回顾性研究针对1176例无HCC病史的慢性HCV患者进行（治疗组[n = 489]和未治疗组[n = 687]）。在治疗组中，接受PEG-IFN/RBV治疗的患者根据持续病毒学应答（SVR）的实现情况分为SVR（+）组和SVR（-）组。所有研究对象的中位随访时间为31个月（范围6 - 144个月）。SVR（+）亚组（1.1%）和SVR（-）亚组（8.6%）的三年累积HCC发生率显著低于未治疗组（13.5%）（分别为P < 0.01和P < 0.01）。在所有研究对象中，肝硬化的存在（风险比[HR]，9.92，P < 0.01）、年龄（HR 1.03，P < 0.01）、SVR（-）（HR 7.02，P < 0.01）和未治疗（HR 6.76，P < 0.01）被发现是HCC发生的独立危险因素。在治疗组中，年龄、肝硬化的存在和SVR（-）是HCC发生的预测因素。在未治疗组中，年龄、男性和肝硬化的存在是HCC发生的独立预测因素。慢性HCV患者中，年龄较大、有肝硬化、PEG-IFN/RBV治疗后SVR（-）以及未接受PEG-IFN/RBV治疗的患者HCC风险增加。对于这些患者，需要考虑基于高效口服药物的积极抗病毒治疗。
