Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Sci Rep. 2017 Jun 16;7(1):3718. doi: 10.1038/s41598-017-02313-y.
This follow-up study enrolled chronic hepatitis C patients to evaluate the treatment efficacy and to identify post-treatment seromarkers associated with risk of hepatocellular carcinoma (HCC) among patients with a sustained virological response (SVR) or nonsustained virological response (NSVR). A total of 4639 patients who received pegylated interferon and ribavirin during 2004-2013 were followed until December 2014. HCC was confirmed through health examinations and data linkage with a national database. A total of 233 HCC cases were reported after 26,163 person-years of follow-up, indicating an incidence of 8.9 per 1000 person-years: 6.9 for SVR and 21.6 for NSVR per 1000 person-years. The associated risk of HCC in patients with SVR was 0.37 (0.22-0.63) for those without cirrhosis and 0.54 (0.31-0.92) for those with cirrhosis compared with their respective counterparts with NSVR. Among patients with SVR, advanced age, male gender, cirrhosis, decreased platelet count, and increased aspartate aminotransferase and α-fetoprotein levels were associated with HCC (p < 0.001). The treatment of chronic hepatitis C patients before they developed cirrhosis showed a higher efficacy than did the treatment of those who had already developed cirrhosis. Patients with SVR may still have a risk of HCC and need to be regularly monitored.
本随访研究纳入慢性丙型肝炎患者，以评估治疗效果，并确定持续病毒学应答（SVR）或非持续病毒学应答（NSVR）患者中与肝细胞癌（HCC）风险相关的治疗后血清标志物。共有 4639 名患者在 2004 年至 2013 年期间接受聚乙二醇干扰素和利巴韦林治疗，随访至 2014 年 12 月。通过健康检查和与国家数据库的数据链接确认 HCC。在 26163 人年的随访中报告了 233 例 HCC 病例，发病率为 8.9/1000 人年：SVR 为 6.9/1000 人年，NSVR 为 21.6/1000 人年。与 NSVR 相比，SVR 患者无肝硬化者 HCC 的相关风险为 0.37（0.22-0.63），肝硬化者为 0.54（0.31-0.92）。在 SVR 患者中，高龄、男性、肝硬化、血小板计数降低以及天门冬氨酸氨基转移酶和甲胎蛋白水平升高与 HCC 相关（p<0.001）。在发生肝硬化之前治疗慢性丙型肝炎患者的疗效高于已经发生肝硬化的患者。SVR 患者仍有 HCC 风险，需要定期监测。
