AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.
Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France.
Liver Int. 2018 Feb;38 Suppl 1:139-145. doi: 10.1111/liv.13659.
Hepatitis C virus infection is a major cause of chronic hepatitis resulting in cirrhosis and hepatocellular carcinoma (HCC). The recent introduction of direct acting antivirals (DAA), results in sustained virological response (SVR) rates of >90% in treated patients whatever the stage of liver fibrosis with an excellent safety profile. This major advancement has allowed treatment of a larger number of patients, some with more advanced liver dysfunction and a higher risk of HCC. An SVR is associated with a reduced risk of hepatic decompensation, the need for liver transplantation and both liver-related and overall mortality. This high rate of SVR has raised hopes that there would be a significant reduction in the incidence of HCC. However, the impact of DAA-based regimens on the occurrence of HCC in patients with cirrhosis, and in particular the recurrence of HCC following successful curative treatment is controversial. Published studies suggest that DAA does not increase the risk of de novo HCC following SVR. A more controversial topic is the effect of a DAA-based SVR on the recurrence of HCC following curative treatment of early HCC. Well-designed studies with robust comparisons are needed to determine the effect of DAA on the recurrence of HCC. At present, patients with HCV cirrhosis who have undergone resection or ablation for HCC should not be dissuaded from receiving DAA therapy to prevent the progression of liver disease. Monitoring for HCC with liver imaging and AFP should be performed twice a year indefinitely post-SVR in patients with HCV cirrhosis.
丙型肝炎病毒感染是导致慢性肝炎、肝硬化和肝细胞癌（HCC）的主要原因。直接作用抗病毒药物（DAA）的最近问世，使得无论肝纤维化处于何种阶段，治疗患者的持续病毒学应答（SVR）率都超过 90%，且安全性良好。这一重大进展使得更多患者能够接受治疗，其中一些患者肝功能更差，肝癌风险更高。SVR 与肝失代偿、肝移植的需求以及与肝脏相关和总体死亡率降低相关。这种高 SVR 率使人们寄希望于 HCC 的发病率会显著降低。然而，DAA 方案对肝硬化患者 HCC 的发生，特别是对成功治疗后 HCC 的复发的影响仍存在争议。已发表的研究表明，DAA 并不会增加 SVR 后新发 HCC 的风险。一个更有争议的话题是 DAA 对早期 HCC 根治性治疗后 HCC 复发的影响。需要设计良好、具有可靠对照的研究来确定 DAA 对 HCC 复发的影响。目前，对于已接受 HCC 切除术或消融术治疗的 HCV 肝硬化患者，不应劝阻其接受 DAA 治疗以防止肝病进展。对于 HCV 肝硬化患者，在 SVR 后应无限期地每年进行两次肝脏影像学和 AFP 监测，以监测 HCC。
