Konjeti Venkata Rajesh, John Binu V
Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Department of Gastroenterology, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA.
Curr Treat Options Gastroenterol. 2018 Jun;16(2):203-214. doi: 10.1007/s11938-018-0178-y.
The approval of direct-acting antiviral (DAA) therapy has revolutionized hepatitis C virus (HCV) treatment. However, the publication of a study from Barcelona in 2016 raised concern for an increased risk of recurrence of hepatocellular carcinoma (HCC) after potentially curative therapy in patients receiving DAAs. This article reviews the current literature on the interaction between HCC and hepatitis C eradication with DAAs.
Following publication of the initial observation in 2016, a number of studies have looked at the impact of active HCC on the success of antiviral therapy, as well as that of treatment with DAAs on both the occurrence and recurrence of HCC. The presence of active HCC decreases sustained virologic response (SVR) rates with DAAs. However, SVR rates improve in patients who have achieved complete radiological response or are treated post transplantation. With respect to occurrence of HCC after DAAs, many small single-center studies without a control group have documented high incidence. The rates are also higher when compared to those of historical controls treated with interferon, but these patients are not comparable because DAA-treated population is more likely to have advanced fibrosis or decompensation. In large studies that have included a control group (patients treated concurrently who did not achieve SVR), a decrease in the occurrence of HCC has been demonstrated. With regard to recurrence of HCC, while smaller single-center studies have shown an increase, larger studies with control group have not replicated those findings. However, methodological limitations in the published studies limit our ability to make a firm conclusion on both the occurrence and recurrence of HCC after DAA therapy. The presence of active HCC decreases treatment success rates with DAAs. Therefore, it is recommended that treatment of HCV in patients with HCC be deferred till there is complete radiological response. Though there are major limitations with the currently published studies, the data does not support an increase in the occurrence or recurrence of HCC after DAA therapy.
直接抗病毒（DAA）疗法的获批彻底改变了丙型肝炎病毒（HCV）的治疗方式。然而，2016年巴塞罗那一项研究的发表引发了人们对接受DAA治疗的患者在接受潜在治愈性治疗后肝细胞癌（HCC）复发风险增加的担忧。本文综述了目前关于HCC与使用DAA根除丙型肝炎之间相互作用的文献。
在2016年首次观察结果发表后，多项研究探讨了活动性HCC对抗病毒治疗成功率的影响，以及DAA治疗对HCC发生和复发的影响。活动性HCC的存在会降低DAA治疗的持续病毒学应答（SVR）率。然而，在实现完全影像学缓解或移植后接受治疗的患者中，SVR率有所提高。关于DAA治疗后HCC的发生情况，许多无对照组的小型单中心研究记录了较高的发病率。与接受干扰素治疗的历史对照组相比，发病率也更高，但这些患者不具有可比性，因为接受DAA治疗的人群更可能有晚期纤维化或失代偿。在纳入对照组（同时接受治疗但未实现SVR的患者）的大型研究中，已证明HCC的发生率有所下降。关于HCC的复发，虽然较小的单中心研究显示有所增加，但有对照组的大型研究并未重复这些发现。然而，已发表研究中的方法学局限性限制了我们就DAA治疗后HCC的发生和复发得出确凿结论的能力。活动性HCC的存在会降低DAA治疗的成功率。因此，建议将HCC患者的HCV治疗推迟至完全影像学缓解后。尽管目前已发表的研究存在重大局限性，但数据并不支持DAA治疗后HCC的发生或复发增加。
