Warzyszyńska Karola, Jonas Maurycy, Wasiak Dariusz, Kosieradzki Maciej, Małkowski Piotr
Medical University of Warsaw, Poland.
Department of General and Transplantation Surgery, Medical University of Warsaw, Poland.
Clin Exp Hepatol. 2017 Dec;3(4):194-197. doi: 10.5114/ceh.2017.71483. Epub 2017 Nov 14.
New interferon-free direct-acting antiviral (DAA) therapy has led to major progress in hepatitis C virus (HCV) treatment. Current outcomes are promising, especially in compensated cirrhosis. However, there are reports of accelerated hepatocellular carcinoma (HCC) recurrence after surgery in patients treated with DAAs. The influence of DAA therapy on the timing and frequency of recurrence after surgical treatment needs further observation.
Fifty-one HCV infected patients with advanced liver cirrhosis and history of surgical treatment for HCC in 2012-2016 were analyzed in a case-control study. Nineteen patients received DAA therapy (DAA group) after tumor remission achieved by surgery and 32 patients were not treated with DAA (NDAA group). Follow-up included multiphase computed tomography scan or magnetic resonance imaging of the liver and alpha-fetoprotein level in 3-6-month intervals.
An sustained virological response was achieved in 18 (95%) DAA treated patients. Hepatocellular carcinoma recurrence was observed in 8 (42.1%) patients from the DAA group and in 21 (65.6%) from the NDAA group ( = 0.058). Relapse occurred within 265 days after surgery in the DAA group vs. 532 days in the NDAA group ( = 0.033). The one-year recurrence-free survival (RFS) rate was 47.3% vs. 75% in the DAA and NDAA group respectively ( = 0.45).
Use of DAA therapy in patients with a history of HCC may result in significantly accelerated relapse of the disease. The number of analyzed patients in this study is too small to state unquestionable conclusions. Further observation with a longer follow-up and larger patient group is needed. The study confirms that contemporary HCV treatment is highly effective.
新型无干扰素直接抗病毒（DAA）疗法在丙型肝炎病毒（HCV）治疗方面取得了重大进展。目前的治疗效果令人鼓舞，尤其是在代偿期肝硬化患者中。然而，有报道称接受DAA治疗的患者术后肝细胞癌（HCC）复发加速。DAA治疗对手术治疗后复发的时间和频率的影响需要进一步观察。
在一项病例对照研究中，分析了2012年至2016年间51例患有晚期肝硬化且有HCC手术治疗史的HCV感染患者。19例患者在手术实现肿瘤缓解后接受了DAA治疗（DAA组），32例患者未接受DAA治疗（非DAA组）。随访包括每3至6个月进行一次肝脏多期计算机断层扫描或磁共振成像以及甲胎蛋白水平检测。
18例（95%）接受DAA治疗的患者实现了持续病毒学应答。DAA组8例（42.1%）患者出现肝细胞癌复发，非DAA组21例（65.6%）患者出现复发（P = 0.058）。DAA组在术后265天内复发，而非DAA组在术后532天复发（P = 0.033）。DAA组和非DAA组的一年无复发生存（RFS）率分别为47.3%和75%（P = 0.45）。
有HCC病史的患者使用DAA治疗可能会导致疾病复发显著加速。本研究中分析的患者数量过少，无法得出确凿结论。需要进行更长时间随访和更大患者群体的进一步观察。该研究证实当代HCV治疗非常有效。
