Egyptian Liver Research Institute and Hospital (ELRIAH), El-Mansoura, Egypt.
Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
J Viral Hepat. 2020 Jul;27(7):671-679. doi: 10.1111/jvh.13276. Epub 2020 Mar 4.
Liver cirrhosis is an important risk factor for hepatocellular carcinoma. The reported annual incidence of HCC is about 3%-8% in CHC cirrhotic patients. Based on the Cochrane systematic review, there was no clear evidence, on the long-term clinical effects of DAAs in patients achieving SVR, as regard liver cirrhosis-related HCC incidence. The aim of the study was to determine the incidence of HCC in chronic hepatitis C patients genotype IV with liver cirrhosis and advanced liver fibrosis after achieving SVR following DAA treatment in a prospective large cohort of HCV patients with long follow-up. This was a prospective observational cohort study including 2372 CHC patients with advanced liver fibrosis or cirrhosis receiving DAA therapy in outpatient clinics at the Egyptian Liver Research Institute and Hospital since January 2015. Liver fibrosis was assessed using transient elastography. Abdominal ultrasonography and AFP measurement were done at baseline and follow-up visits every 6 months, in addition to triphasic abdominal MSCT when needed. Patients were followed up after achieving SVR12 for at least 12 months. HCC developed in 109 cases during the follow-up period (mean 23.60 ± 8.25 months). Overall HCC incidence was 2.338/100 PY, 95% CI = 1.942-2.814. In patients with cirrhosis, the incidence of HCC was 2.917/100 PY, 95% CI = 2.407-3.535, while in patients with advanced liver fibrosis the incidence of HCC was 0.664/100 PY, 95% CI = 0.333-1.326. In conclusion, the incidence of HCC was reduced in chronic hepatitis C genotype 4 patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3) who achieved SVR following DAA therapy.
肝硬化是肝细胞癌的重要危险因素。在慢性丙型肝炎（CHC）肝硬化患者中，HCC 的年发病率约为 3%-8%。基于 Cochrane 系统评价，在 SVR 患者中，DAA 治疗的长期临床效果在肝硬化相关 HCC 发病率方面没有明确证据。本研究旨在确定接受 DAA 治疗后实现 SVR 的慢性丙型肝炎病毒基因型 4 合并肝硬化和晚期纤维化患者的 HCC 发生率。这是一项前瞻性观察性队列研究，纳入了自 2015 年 1 月以来在埃及肝脏研究所和医院的门诊接受 DAA 治疗的 2372 例 CHC 患者，这些患者存在晚期肝纤维化或肝硬化。使用瞬时弹性成像评估肝纤维化。基线和随访时每 6 个月进行腹部超声和 AFP 检测，必要时进行三期腹部 MSCT。在实现 SVR12 后，患者至少随访 12 个月。在随访期间（平均 23.60±8.25 个月）有 109 例患者发生 HCC。总的 HCC 发生率为 2.338/100 人年，95%CI=1.942-2.814。在肝硬化患者中，HCC 的发生率为 2.917/100 人年，95%CI=2.407-3.535，而在晚期肝纤维化患者中，HCC 的发生率为 0.664/100 人年，95%CI=0.333-1.326。总之，在接受 DAA 治疗后实现 SVR 的慢性丙型肝炎病毒基因型 4 合并肝硬化（F4）和晚期肝纤维化（F3）患者中，HCC 的发生率降低。
