Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Ehime, Japan.
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
PLoS One. 2018 Apr 16;13(4):e0194704. doi: 10.1371/journal.pone.0194704. eCollection 2018.
This study aimed to elucidate whether interferon (IFN)-free direct-acting antiviral (DAA) therapy for hepatitis C after curative treatment of hepatocellular carcinoma (HCC) promotes HCC recurrence in a real-world large-scale cohort.
This multicenter study was conducted by the Japanese Red Cross Hospital Liver Study Group. This retrospective study analyzed 516 patients who underwent antiviral treatment for hepatitis C with either IFN (n = 148) or IFN-free DAA (n = 368) after curative HCC treatment; 78 IFN-treated patients and 347 IFN-free DAA-treated patients achieved sustained virological response (SVR). The recurrence rate of HCC was compared between the antiviral therapies. Logistic analysis and Cox proportional hazards analysis identified factors associated with early recurrence of HCC within 24 weeks of antiviral therapy and recurrence throughout the observation period, respectively.
AFP at the completion of antiviral therapy, clinical stage of HCC, and non-SVR were independent factors associated with early recurrence of HCC. Among patients who had achieved SVR, the clinical stage of HCC and the level of AFP at completion of antiviral therapy were independent factors associated with early recurrence of HCC. For recurrence throughout the observation period in SVR patients, AFP at completion of antiviral therapy, duration between last HCC treatment to antiviral therapy, and the number of treatments were independent factors. There was no significant difference in the rate of early recurrence of HCC or recurrence throughout the observation period between IFN and IFN-free DAA treated patients.
There were no differences in the early recurrence rate of HCC between patients who underwent IFN and those who underwent IFN-free DAA as antiviral therapies.
本研究旨在阐明慢性丙型肝炎病毒（HCV）治愈性治疗后，无干扰素（IFN）直接作用抗病毒（DAA）治疗是否会促进肝癌（HCC）的复发。
这项多中心研究由日本红十字会医院肝脏研究组进行。这项回顾性研究分析了 516 例接受抗病毒治疗的患者，这些患者在 HCC 治愈性治疗后接受 IFN（n=148）或 IFN 免费 DAA（n=368）治疗；78 例 IFN 治疗患者和 347 例 IFN 免费 DAA 治疗患者获得持续病毒学应答（SVR）。比较两种抗病毒治疗方案 HCC 复发率。Logistic 分析和 Cox 比例风险分析分别确定了与抗病毒治疗后 24 周内 HCC 早期复发和整个观察期间 HCC 复发相关的因素。
抗病毒治疗结束时的 AFP、HCC 临床分期和非 SVR 是与 HCC 早期复发相关的独立因素。在获得 SVR 的患者中，HCC 的临床分期和抗病毒治疗结束时的 AFP 水平是与 HCC 早期复发相关的独立因素。对于 SVR 患者整个观察期间的复发，抗病毒治疗结束时的 AFP、上次 HCC 治疗至抗病毒治疗的时间间隔以及治疗次数是独立的因素。在 IFN 和 IFN 免费 DAA 治疗患者中，HCC 的早期复发率或整个观察期间的复发率均无显著差异。
在 IFN 和 IFN 免费 DAA 作为抗病毒治疗方案时，HCC 的早期复发率没有差异。
