Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Clin Gastroenterol. 2018 Jul;52(6):557-562. doi: 10.1097/MCG.0000000000000923.
BACKGROUND/AIM: Advances in hepatitis C virus (HCV) treatment offer high sustained virologic response rates with minimal side-effects. However, benefits of eradicating HCV in hepatocellular carcinoma (HCC) patients whose life expectancies are hard to be determined after palliative therapy still needs to be assessed. This study sought to evaluate prognostic factors for survival in HCV-related HCC patients that responded to the palliative HCC treatment to speculate whether treating HCV would be beneficial in these patients.
In this retrospective cohort study, the medical records of 97 patients that showed complete or partial response to the initial HCC treatment were included.
Receiving HCV treatment [hazard ratio (HR), 0.244; 95% confidence interval (CI), 0.075-0.788; P=0.018] increased the survival, whereas partial response to the initial HCC treatment (HR, 1.795; 95% CI, 1.071-3.008; P=0.026) and increased Child-Turcotte-Pugh score (HR, 2.017; 95% CI, 1.196-3.403; P=0.009) reduced the survival. From 97 patients, 16 patients were eventually treated for HCV. The mean time from the last HCC therapy to HCV treatment was 16.9±13.9 months. The median time of follow-up after HCV treatment was 10.0 months (range, 3 to 47 mo). Among the HCV-treated patients 3 patients had HCC recurred. The time to progression in HCV-treated patients were significantly longer than those untreated for HCV (P=0.032).
Although treating HCV in HCC patient that undergo noncurative HCC treatment is still debatable, this study results carefully suggest that HCV-related HCC patients that responded to the initial HCC palliative treatment might benefit from HCV treatment.
背景/目的：丙型肝炎病毒（HCV）治疗的进步为接受姑息性 HCC 治疗后生存期难以确定的 HCC 患者提供了高持续病毒学应答率和最小的副作用。然而，消除 HCV 在 HCC 患者中的益处仍需要评估，这些患者的 HCC 接受姑息性治疗后反应良好，但预期寿命难以确定。本研究旨在评估对初始 HCC 治疗有部分或完全反应的 HCV 相关 HCC 患者的生存预后因素，以推测治疗 HCV 是否对这些患者有益。
在这项回顾性队列研究中，纳入了 97 例对初始 HCC 治疗有完全或部分反应的患者的病历。
接受 HCV 治疗[风险比（HR），0.244；95%置信区间（CI），0.075-0.788；P=0.018]增加了生存率，而初始 HCC 治疗的部分反应（HR，1.795；95%CI，1.071-3.008；P=0.026）和增加的 Child-Turcotte-Pugh 评分（HR，2.017；95%CI，1.196-3.403；P=0.009）降低了生存率。97 例患者中，最终有 16 例接受了 HCV 治疗。从最后一次 HCC 治疗到 HCV 治疗的平均时间为 16.9±13.9 个月。HCV 治疗后的中位随访时间为 10.0 个月（范围 3 至 47 个月）。在接受 HCV 治疗的患者中，有 3 例 HCC 复发。接受 HCV 治疗的患者的疾病进展时间明显长于未接受 HCV 治疗的患者（P=0.032）。
虽然对接受姑息性 HCC 治疗的 HCC 患者进行 HCV 治疗仍存在争议，但本研究结果谨慎提示，对初始 HCC 姑息性治疗有反应的 HCV 相关 HCC 患者可能从 HCV 治疗中获益。
