直接作用抗病毒药物治疗丙型肝炎后肝细胞癌的短期发病率并未增加：一项 ERCHIVES 研究。

The short-term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct-acting antivirals: An ERCHIVES study.

机构信息

Department of Medicine, Massachusetts General Hospital, Boston, MA.

Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA.

出版信息

Hepatology. 2018 Jun;67(6):2244-2253. doi: 10.1002/hep.29707. Epub 2018 Apr 19.

DOI:10.1002/hep.29707

PMID:29205416

Abstract

UNLABELLED

Recent studies have reported higher rates of hepatocellular carcinoma (HCC) in individuals treated with direct-acting antivirals (DAAs). However, making definitive conclusions has been challenging because of the heterogeneous populations and methodologies of these reports. We investigated whether DAA use is associated with higher rates of incident HCC compared to treatment with interferon (IFN)-based regimens. We performed a retrospective, population-based cohort study using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database. In a cohort of 17,836 persons, sustained virological response (SVR) was achieved by 66.6% and 96.2% of the IFN and DAA groups, respectively. Among all treated persons, risk of HCC was not higher in the DAA group compared to the IFN group (hazard ratio, 1.07; 95% confidence interval, 0.55, 2.08). Among persons with cirrhosis who achieved SVR, neither the HCC incidence rate nor HCC-free survival were significantly different in the DAA group compared to the IFN group (21.2 vs. 22.8 per 1,000 person-years; P = 0.78 and log-rank P = 0.17, respectively). Untreated persons with cirrhosis had a significantly higher HCC incidence rate (45.3 per 1,000 person-years) compared to those treated with either IFN or DAAs (P = 0.03). Both groups of treated persons had significantly lower probability of HCC development compared to untreated persons (log-rank, P = 0.0004).

CONCLUSION

DAA treatment is not associated with a higher risk of HCC in persons with cirrhosis with chronic HCV infection in the short term. Previously reported higher rates of HCC associated with DAA treatment may be explained by both the presence of relatively fewer baseline HCC risk factors in persons treated with IFN as well as selection bias, given that DAA regimens were used to treat persons at higher risk for developing HCC. (Hepatology 2018;67:2244-2253).

摘要

未标注

最近的研究报告称，接受直接作用抗病毒药物（DAA）治疗的个体肝细胞癌（HCC）发病率较高。然而，由于这些报告的人群和方法学存在异质性，因此很难得出明确的结论。我们研究了与使用干扰素（IFN）为基础的方案相比，DAA 的使用是否与更高的 HCC 发生率相关。我们使用电子检索 HCV 感染退伍军人队列（ERCHIVES）数据库进行了回顾性、基于人群的队列研究。在 17836 名患者中，IFN 组和 DAA 组的持续病毒学应答（SVR）分别达到 66.6%和 96.2%。在所有接受治疗的患者中，DAA 组的 HCC 风险并不高于 IFN 组（风险比，1.07；95%置信区间，0.55，2.08）。在获得 SVR 的肝硬化患者中，DAA 组与 IFN 组的 HCC 发生率或 HCC 无复发生存率均无显著差异（每 1000 人年分别为 21.2 例和 22.8 例；P = 0.78 和对数秩 P = 0.17）。未治疗的肝硬化患者的 HCC 发生率（每 1000 人年 45.3 例）明显高于接受 IFN 或 DAA 治疗的患者（P = 0.03）。与未治疗的患者相比，两组治疗患者的 HCC 发生概率均显著降低（对数秩，P = 0.0004）。

结论

在短期内，慢性 HCV 感染的肝硬化患者中，DAA 治疗与 HCC 风险的增加无关。先前报道的与 DAA 治疗相关的 HCC 发生率较高可能归因于 IFN 治疗患者的基线 HCC 风险因素相对较少，以及选择偏倚，因为 DAA 方案用于治疗 HCC 风险较高的患者。（《肝脏病学》2018 年；67：2244-2253）