在基线肝硬化或高 FIB-4 评分的患者中，HCV 清除后长达 10 年仍存在肝细胞癌风险增加。
Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients With Baseline Cirrhosis or High FIB-4 Scores.
机构信息
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington; Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington.
Division of General Internal Medicine, Department of Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington.
出版信息
Gastroenterology. 2019 Nov;157(5):1264-1278.e4. doi: 10.1053/j.gastro.2019.07.033. Epub 2019 Jul 26.
BACKGROUND & AIMS: It is unclear if hepatocellular carcinoma (HCC) risk declines over time after hepatitis C virus (HCV) eradication. We analyzed changes in HCC annual incidence over time following HCV eradication and identified dynamic markers of HCC risk.
METHODS
We identified 48,135 patients who initiated HCV antiviral treatment from 2000 through 2015 and achieved a sustained virologic response (SVR) in the Veterans Health Administration (29,033 treated with direct-acting antiviral [DAA] agents and 19,102 treated with interferon-based regimens). Patients were followed after treatment until February 14, 2019 (average 5.4 years), during which 1509 incident HCCs were identified.
RESULTS
Among patients with cirrhosis before treatment with DAAs (n = 9784), those with pre-SVR fibrosis-4 (FIB-4) scores ≥3.25 had a higher annual incidence of HCC (3.66%/year) than those with FIB-4 scores <3.25 (1.16%/year) (adjusted hazard ratio 2.14; 95% confidence interval 1.66-2.75). In DAA-treated patients with cirrhosis and FIB-4 scores ≥3.25, annual HCC risk decreased from 3.8%/year in the first year after SVR to 2.4%/year by the fourth year (P=.01). In interferon-treated patients with FIB-4 scores ≥3.25, annual HCC risk remained above 2%/year, even 10 years after SVR. A decrease in FIB-4 scores from ≥3.25 pre-SVR to <3.25 post-SVR was associated with an approximately 50% lower risk of HCC, but the absolute annual risk remained above 2%/year. Patients without cirrhosis before treatment (n = 38,351) had a low risk of HCC, except for those with pre-SVR FIB-4 scores ≥3.25 (HCC risk 1.22%/year) and post-SVR FIB-4 scores ≥3.25 (HCC risk 2.39%/year); risk remained high for many years after SVR.
CONCLUSIONS
Patients with cirrhosis before an SVR to treatment for HCV infection continue to have a high risk for HCC (>2%/year) for many years, even if their FIB-4 score decreases, and should continue surveillance. Patients without cirrhosis but with FIB-4 scores ≥3.25 have a high enough risk to merit HCC surveillance, especially if FIB-4 remains ≥3.25 post-SVR.
背景与目的
尚不清楚丙型肝炎病毒（HCV）清除后肝癌（HCC）的风险是否随时间降低。我们分析了 HCV 清除后 HCC 发病率随时间的变化，并确定了 HCC 风险的动态标志物。
方法
我们在退伍军人健康管理局（Veterans Health Administration）中确定了 48135 名 2000 年至 2015 年间接受 HCV 抗病毒治疗且获得持续病毒学应答（SVR）的患者（29033 名接受直接作用抗病毒[DAA]药物治疗，19102 名接受基于干扰素的方案治疗）。在治疗后，患者接受随访直至 2019 年 2 月 14 日（平均随访 5.4 年），在此期间发现 1509 例 HCC 事件。
结果
在接受 DAA 治疗的肝硬化患者（n=9784）中，治疗前纤维化-4（FIB-4）评分≥3.25 的患者 HCC 年发病率（3.66%/年）高于 FIB-4 评分<3.25 的患者（1.16%/年）（校正风险比 2.14；95%置信区间 1.66-2.75）。在肝硬化且 FIB-4 评分≥3.25 的 DAA 治疗患者中，SVR 后第 1 年 HCC 年风险为 3.8%/年，第 4 年降至 2.4%/年（P=0.01）。在 FIB-4 评分≥3.25 的接受干扰素治疗的患者中，即使在 SVR 后 10 年，HCC 年风险仍保持在 2%/年以上。治疗前 FIB-4 评分从≥3.25 降至<3.25 与 HCC 风险降低约 50%相关，但绝对 HCC 年风险仍保持在 2%/年以上。治疗前无肝硬化的患者（n=38351） HCC 风险较低，但治疗前 FIB-4 评分≥3.25（HCC 风险 1.22%/年）和 SVR 后 FIB-4 评分≥3.25（HCC 风险 2.39%/年）的患者除外；SVR 后多年 HCC 风险仍较高。
结论
接受 HCV 感染治疗获得 SVR 的肝硬化患者在多年内仍有很高的 HCC 风险（>2%/年），即使其 FIB-4 评分下降，也应继续监测。无肝硬化但 FIB-4 评分≥3.25 的患者 HCC 监测风险足够高，尤其是 FIB-4 在 SVR 后仍≥3.25 时。
Zotero 插件