School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
Glasgow Royal Infirmary, Glasgow, UK.
J Hepatol. 2018 Apr;68(4):646-654. doi: 10.1016/j.jhep.2017.10.033. Epub 2017 Nov 16.
BACKGROUND & AIMS: Previous studies have reported a high frequency of hepatocellular carcinoma (HCC) occurrence in patients with advanced liver disease, after receipt of interferon (IFN)-free therapy for hepatitis C virus (HCV) infection. Our objective was to verify and account for this phenomenon using data from the Scottish HCV clinical database.
We identified HCC-naïve individuals with liver cirrhosis receiving a course of antiviral therapy in Scotland from 1997-2016 resulting in a sustained virologic response. Patients were followed-up from their treatment start date to the earliest of: date of death, date of HCC occurrence, or 31 January 2017. We used Cox regression to compare the risk of HCC occurrence according to treatment regimen after adjusting for relevant co-factors (including: demographic factors; baseline liver disease stage; comorbidities/health behaviours, virology, and previous treatment experience). HCC occurrence was ascertained through both the HCV clinical database and medical chart review. For our main analysis, treatment regimen was defined as IFN-free vs. IFN-containing.
A total of 857 patients met the study criteria, of whom 31.7% received an IFN-free regimen. Individuals receiving IFN-free therapy were more likely to be: older; of white ethnicity, Child-Turcotte-Pugh B/C vs. Child-Turcotte-Pugh A; thrombocytopenic; non-genotype 3; and treatment experienced. HCC occurrence was observed in 46 individuals during follow-up. In univariate analysis, IFN-free therapy was associated with a significantly increased risk of HCC (HR: 2.48; p = 0.021). However, after multivariate adjustment for baseline factors, no significant risk attributable to IFN-free therapy persisted (aHR: 1.15, p = 0.744).
These findings suggest that the higher incidence of HCC following sustained virologic response with IFN-free therapy relates to baseline risk factors/patient selection, and not the use of IFN-free therapy per se.
We examined the risk of liver cancer in 857 patients with cirrhosis in Scotland who received hepatitis C antiviral therapy and achieved a cure. We compared the risk of first-time liver cancer in patients treated with the newest interferon-free regimens, to patients treated with interferon. After accounting for the different characteristics of these two treatment groups, we found no evidence that interferon-free therapy is associated with a higher risk of liver cancer.
先前的研究报告显示，在接受丙型肝炎病毒（HCV）感染的无干扰素治疗后，患有晚期肝病的患者发生肝细胞癌（HCC）的频率很高。我们的目的是使用苏格兰 HCV 临床数据库中的数据来验证并解释这一现象。
我们从 1997 年至 2016 年期间在苏格兰接受抗病毒治疗的肝硬化 HCC 初治个体中确定了 HCC 患者。患者从治疗开始日期开始随访，最早的时间为：死亡日期、HCC 发生日期或 2017 年 1 月 31 日。我们使用 Cox 回归来比较根据治疗方案调整相关协变量（包括：人口统计学因素；基线肝病分期；合并症/健康行为、病毒学和既往治疗经验）后 HCC 发生的风险。HCC 的发生通过 HCV 临床数据库和病历审查来确定。在我们的主要分析中，治疗方案定义为无干扰素与含干扰素。
共有 857 名患者符合研究标准，其中 31.7%接受了无干扰素方案。接受无干扰素治疗的个体更可能为：年龄较大；白种人；Child-Turcotte-Pugh B/C 比 Child-Turcotte-Pugh A；血小板减少；非基因型 3；和治疗经验丰富。在随访期间，有 46 名患者发生 HCC。单变量分析显示，无干扰素治疗与 HCC 发生风险显著增加相关（HR：2.48；p=0.021）。然而，在调整基线因素后的多变量校正后，无干扰素治疗无显著归因风险（aHR：1.15，p=0.744）。
这些发现表明，无干扰素治疗后持续病毒学应答与 HCC 发生率较高与基线危险因素/患者选择有关，而不是无干扰素治疗本身。
我们研究了苏格兰 857 名接受 HCV 抗病毒治疗并治愈的肝硬化患者的肝癌风险。我们比较了使用最新无干扰素方案治疗的患者与干扰素治疗的患者的首次肝癌风险。在考虑到这两组治疗的不同特征后，我们没有发现无干扰素治疗与更高的肝癌风险相关的证据。
