Abdelaziz Ashraf O, Nabil Mohamed M, Abdelmaksoud Ahmed H, Shousha Hend I, Cordie Ahmed A, Hassan Eman M, Omran Dalia A, Leithy Rania, Elbaz Tamer M
Departments of Endemic Medicine and Hepato-gastroenterology.
Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur J Gastroenterol Hepatol. 2018 Jan;30(1):39-43. doi: 10.1097/MEG.0000000000001004.
A recent appearance of direct-acting antivirals (DAAs) led to a surge in hepatitis C virus (HCV) management. Nowadays, a large proportion of treated patients have cirrhosis with a retained possibility to develop hepatocellular carcinoma (HCC) even after complete cure. We aimed to study tumoral differences between patients who developed HCC after DAAs as either a recurrence or de-novo HCC.
We retrospectively analyzed 89 patients who presented to our HCC multidisciplinary clinic with HCC lesions following DAA therapy. A total of 45 patients had complete response to HCC according to the modified Response Evaluation Criteria in Solid Tumors before DAAs intake. Another 44 patients developed de-novo lesions after DAA treatment. Both groups were compared regarding their baseline characteristics, tumor criteria, response to DAAs as well response to HCC treatment.
Both groups showed no significant difference regarding their baseline characteristics (age, sex, Child-Pugh score, and performance status) or response to DAAs (P=0.5). No significant difference was present between groups according to number, site, and size of lesions. However, time elapsed between the end of DAAs therapy and first diagnosis of HCC was significantly longer in de-novo group (15.22±16.39 months) versus recurrence group (6.76±5.1 months) (P=0.008). In addition, response to ablation was significantly better in de-novo lesions compared with recurrent HCC (P=0.03).
Although de-novo HCC lesions significantly developed later than recurrent lesions in DAAs-treated patients, their response rates were significantly better. No differences were detected between both groups in their response to DAAs and their tumoral characteristics.
直接作用抗病毒药物（DAA）的近期出现促使丙型肝炎病毒（HCV）管理有了显著进展。如今，很大一部分接受治疗的患者患有肝硬化，即便完全治愈后仍有发生肝细胞癌（HCC）的可能性。我们旨在研究DAA治疗后发生HCC的患者中，作为复发或新发HCC的肿瘤差异。
我们回顾性分析了89例在接受DAA治疗后出现HCC病变并就诊于我们HCC多学科诊所的患者。根据实体瘤改良疗效评价标准，在摄入DAA之前，共有45例患者对HCC有完全缓解。另外44例患者在DAA治疗后出现新发病变。比较了两组患者的基线特征、肿瘤标准、对DAA的反应以及对HCC治疗的反应。
两组在基线特征（年龄、性别、Child-Pugh评分和体能状态）或对DAA的反应方面均无显著差异（P = 0.5）。根据病变数量、部位和大小，两组之间无显著差异。然而，新发组从DAA治疗结束到首次诊断为HCC的时间间隔（15.22±16.39个月）明显长于复发组（6.76±5.1个月）（P = 0.008）。此外，与复发性HCC相比，新发病变对消融的反应明显更好（P = 0.03）。
尽管在接受DAA治疗的患者中，新发HCC病变的发生明显晚于复发性病变，但其缓解率明显更高。两组在对DAA的反应和肿瘤特征方面未检测到差异。
