直接作用抗病毒药物对根治性治疗后丙型肝炎病毒相关肝细胞癌的影响。
The influence of direct-acting antivirals in hepatitis C virus related hepatocellular carcinoma after curative treatment.
机构信息
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Rd, Niao-Sung, 833, Kaohsiung City, Taiwan.
Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
出版信息
Invest New Drugs. 2020 Feb;38(1):202-210. doi: 10.1007/s10637-019-00870-9. Epub 2019 Nov 8.
This study was done to elucidate the influence of direct-acting antiviral (DAA) agents on the recurrence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related HCC (HCV-HCC) after curative therapies. HCV-HCC patients who received curative therapies and obtained a complete response were analyzed. From January 2017 to September 2017, 112 HCV-HCC patients received DAA and obtained a sustained virological response (SVR). From January 2006 to December 2014, another 345 HCV-HCC patients received peg-interferon-based treatment and 118 obtained SVR. From January 2012 to December 2016, 248 HCV-HCC patients had complete HCC response and did not receive antiviral treatment. Patients were divided into DAA, IFN, and Untreated groups based on what antiviral treatment they received. There were 82 patients in the DAA group, 80 patients in the IFN group, and 160 patients in the Untreated group. During the follow-up period, the DAA group had 22 (26.8%) recurrent cases, whereas the IFN group had 46 (56.8%) cases after antiviral treatment. Among the 22 recurrent cases in the DAA group, 19 (86.9%) experienced HCC recurrence during 1 year after DAA initiation. Compared with the IFN group, the DAA group had poorer one-year recurrence-free survival (75.4% vs. 95%, p < 0.001), even after adjustment with propensity score matching (81.4% vs. 93.9%, p = 0.034). However, DAA was an improving factor for HCC recurrence compared with the Untreated group in the multivariate analysis. Among HCV-HCC patients with complete treatment, those with DAA-induced SVR had a higher one-year recurrence rate than those who received IFN-based antiviral therapy, but DAA did not seem to increase HCC recurrence compared to untreated patients.
本研究旨在阐明直接作用抗病毒（DAA）药物对接受根治性治疗后获得完全缓解的丙型肝炎病毒（HCV）相关肝细胞癌（HCC）患者的 HCC 复发的影响。
对接受根治性治疗并获得完全缓解的 HCV-HCC 患者进行了分析。2017 年 1 月至 9 月，112 例 HCV-HCC 患者接受 DAA 治疗并获得持续病毒学应答（SVR）。2006 年 1 月至 2014 年 12 月，另有 345 例 HCV-HCC 患者接受聚乙二醇干扰素治疗并获得 118 例 SVR。2012 年 1 月至 2016 年 12 月，248 例 HCV-HCC 患者 HCC 完全缓解且未接受抗病毒治疗。根据接受的抗病毒治疗方案，将患者分为 DAA 组、IFN 组和未治疗组。DAA 组 82 例，IFN 组 80 例，未治疗组 160 例。在随访期间，DAA 组有 22 例（26.8%）复发，而 IFN 组有 46 例（56.8%）在抗病毒治疗后复发。在 DAA 组的 22 例复发患者中，19 例（86.9%）在 DAA 治疗开始后 1 年内复发 HCC。与 IFN 组相比，DAA 组 1 年无复发生存率较差（75.4%比 95%，p<0.001），即使在倾向评分匹配后也如此（81.4%比 93.9%，p=0.034）。然而，在多变量分析中，与未治疗组相比，DAA 是 HCC 复发的改善因素。在完全治疗的 HCV-HCC 患者中，DAA 诱导 SVR 的患者 1 年复发率高于接受 IFN 抗病毒治疗的患者，但与未治疗患者相比，DAA 似乎并未增加 HCC 复发。
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