Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine (DI.BI.M.I.S.), University of Palermo, Palermo, Italy.
Department of Medical and Surgical Sciences Semeiotica Medica, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
J Hepatol. 2017 Jul;67(1):65-71. doi: 10.1016/j.jhep.2017.01.033. Epub 2017 Feb 10.
BACKGROUND & AIMS: Assessment of long-term outcome is required in hepatitis C virus (HCV)-infected patients with cirrhosis, who have been successfully treated for Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC). However, problems arise due to the lack of models accounting for early changes during follow-up. The aim of this study was to estimate the impact of early events (HCC recurrence or hepatic decompensation within 12months of complete radiological response) on 5-year overall survival (OS) in a large cohort of patients with HCV and cirrhosis, successfully treated HCC.
A total of 328 consecutive Caucasian patients with HCV-related cirrhosis and BCLC stage 0/A HCC who had complete radiological response after curative resection or thermal ablation were prospectively recruited to this study. Primary endpoint of the study was 5-year OS. Independent baseline and time-dependent predictors of 5-year OS were identified by Cox model.
The observed 5-year survival rate was 44%. The observed HCC early recurrence and early hepatic decompensation rate were 21% and 10%, respectively. Early hepatic decompensation (Hazard Ratio [HR] 7.52; 95% confidence intervals (CI): 1.23-13.48) and HCC early recurrence as time-dependent covariates (HR 2.50; 95%CI: 1.23-5.05), presence of esophageal varices at baseline (HR 1.66; 95% CI: 1.02-2.70) and age (HR 1.04; 95% CI: 1.02-1.07) were significantly associated with the 5-year OS.
Survival in HCV-infected patients with cirrhosis and successfully treated HCC is influenced by early hepatic decompensation. Our study indirectly suggests that direct-acting antiviral agents could improve OS of HCC patients through long-term preservation of liver function, resulting in a lower cirrhosis-related mortality and a greater change of receiving curative treatments.
Survival in hepatitis C virus (HCV) infected patients with cirrhosis and successfully treated hepatocellular carcinoma (HCC), is mainly influenced by early hepatic decompensation. HCV eradication after treatment with new direct-acting antiviral agents could improve overall survival of HCC patients through long-term preservation of liver function.
成功治疗巴塞罗那临床肝癌（BCLC）分期 A 期肝细胞癌（HCC）的丙型肝炎病毒（HCV）感染肝硬化患者需要进行长期预后评估。然而，由于缺乏能够解释随访期间早期变化的模型，因此存在问题。本研究旨在评估大量 HCV 相关肝硬化和 BCLC 0/A 期 HCC 患者中，在完全放射学反应后 12 个月内 HCC 复发或肝失代偿等早期事件对 5 年总生存率（OS）的影响。
前瞻性招募了 328 例连续的白人丙型肝炎相关肝硬化和 BCLC 0/A 期 HCC 患者，这些患者在根治性切除或热消融后获得完全放射学反应。本研究的主要终点是 5 年 OS。通过 Cox 模型确定 5 年 OS 的独立基线和时间依赖性预测因素。
观察到的 5 年生存率为 44%。观察到的 HCC 早期复发和早期肝失代偿的发生率分别为 21%和 10%。早期肝失代偿（风险比[HR]7.52；95%置信区间[CI]：1.23-13.48）和 HCC 早期复发作为时间依赖性协变量（HR 2.50；95%CI：1.23-5.05）、基线时存在食管静脉曲张（HR 1.66；95%CI：1.02-2.70）和年龄（HR 1.04；95%CI：1.02-1.07）与 5 年 OS 显著相关。
HCV 感染合并肝硬化且成功治疗 HCC 的患者的生存受到早期肝失代偿的影响。我们的研究间接表明，直接作用抗病毒药物可以通过长期维持肝功能来提高 HCC 患者的 OS，从而降低肝硬化相关死亡率，并使更多患者能够接受根治性治疗。
成功治疗丙型肝炎病毒（HCV）感染合并肝硬化和肝细胞癌（HCC）患者的生存主要受早期肝失代偿的影响。新的直接作用抗病毒药物治疗后 HCV 清除可通过长期维持肝功能来提高 HCC 患者的总体生存率。
