Griffith Anna S, Hayashi Paul H, Burke Lauren Mb, McRee Autumn J
Department of Medicine.
Department of Radiology, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA.
J Hepatocell Carcinoma. 2018 May 31;5:55-59. doi: 10.2147/JHC.S152569. eCollection 2018.
We describe two cases of patients with hepatitis C virus (HCV) treated with direct-acting antiviral (DAA) therapy who had dramatic improvement in hepatocellular carcinoma (HCC) tumor burden with DAA therapy alone. Both patients were diagnosed with HCC on screening magnetic resonance imaging shortly after beginning DAA therapy. Both patients achieved sustained virologic response (SVR) with dramatic improvement in HCC tumor burden on follow-up imaging without HCC treatment. Patients with multifocal or advanced HCC are infrequently treated with antiviral therapy for HCV. As a result, these cases provide unique insight into the ongoing debate regarding the impact of SVR on existing and recurrent HCC. We review the current literature regarding this debate, as well as the theory of immunosurveillance. We postulate that DAA therapy activates CD8 T cells to induce a T-cell-mediated response and increased immunosurveillance to virus-induced liver cancer.
我们描述了两例接受直接抗病毒（DAA）治疗的丙型肝炎病毒（HCV）患者，他们仅通过DAA治疗，肝细胞癌（HCC）肿瘤负担就有显著改善。两名患者在开始DAA治疗后不久，经筛查磁共振成像被诊断为HCC。两名患者均实现了持续病毒学应答（SVR），在后续成像中HCC肿瘤负担显著改善，且未接受HCC治疗。多灶性或晚期HCC患者很少接受HCV抗病毒治疗。因此，这些病例为正在进行的关于SVR对现有和复发性HCC影响的辩论提供了独特见解。我们回顾了关于这场辩论的当前文献以及免疫监视理论。我们推测，DAA治疗激活CD8 T细胞以诱导T细胞介导的反应，并增强对病毒诱导肝癌的免疫监视。
