Dept. of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", Naples, Italy.
Dept. of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital, Humanitas University, Rozzano, Milan, Italy.
Dig Liver Dis. 2018 Nov;50(11):1105-1114. doi: 10.1016/j.dld.2018.08.001. Epub 2018 Aug 11.
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, data are conflicting regarding risk and aggressiveness of recurrence in patients who have a history of treated HCC. This review analyses data available in literature in order to elucidate the impact of DAAs on the risk of HCC recurrence after successful treatment of the tumor. Overall 24 papers were identified. The available data cannot be considered definitive, but the initial alarmist data indicating an increased risk of recurrence have not been confirmed by most subsequent studies. The suggested aggressive pattern (rapid growth and vascular invasion) of tumor recurrence after DAAs still remains to be confirmed. Several limitations of the available studies were highlighted, and should drive future researches. The time-to-recurrence should be computed since the last HCC treatment and results stratified for cirrhosis and sustained viral response. Any comparison with historical series is of limited interest because of a number of biases affecting these studies and differences between enrolled patients. Prospective intention-to-treat analyses will be probably the best contribution to drive clinical practice, provided that a randomized trial can be difficult to design.
虽然研究表明，直接作用抗病毒药物（DAAs）治疗丙型肝炎病毒（HCV）感染后，肝细胞癌（HCC）的发病率降低，但关于有治疗过 HCC 病史的患者复发的风险和侵袭性，数据仍存在争议。本综述分析了文献中的现有数据，以阐明 DAA 对成功治疗肿瘤后 HCC 复发风险的影响。共确定了 24 篇论文。现有数据尚不能被认为是明确的，但最初表明复发风险增加的危言耸听的数据并未被大多数后续研究所证实。DAA 后肿瘤复发的侵袭性模式（快速生长和血管侵犯）仍有待证实。突出了现有研究的几个局限性，这些局限性应推动未来的研究。应自上次 HCC 治疗后开始计算复发时间，并根据肝硬化和持续病毒应答对结果进行分层。由于影响这些研究的多种偏倚以及纳入患者之间的差异，与历史系列的任何比较都具有一定的局限性。前瞻性意向治疗分析可能是对临床实践最有帮助的方法，前提是随机试验可能难以设计。
