抗病毒治疗后慢性丙型肝炎患者的肝外恶性肿瘤：基于台湾慢性丙型肝炎队列（T-COACH）的真实世界全国性研究。
Extrahepatic Malignancy Among Patients With Chronic Hepatitis C After Antiviral Therapy: A Real-World Nationwide Study on Taiwanese Chronic Hepatitis C Cohort (T-COACH).
机构信息
Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.
出版信息
Am J Gastroenterol. 2020 Aug;115(8):1226-1235. doi: 10.14309/ajg.0000000000000606.
INTRODUCTION
Chronic hepatitis C virus (HCV) infection is associated with nonhepatocellular carcinoma malignancies. We aimed to evaluate whether achieving a sustained virological response (SVR, defined as HCV RNA seronegativity throughout posttreatment 24-week follow-up) could reduce the risk of non-hepatocellular carcinoma malignancy in a real-world nationwide Taiwanese Chronic Hepatitis C Cohort (T-COACH).
METHODS
A total of 10,714 patients with chronic hepatitis C who had received interferon-based therapy (8,186 SVR and 2,528 non-SVR) enrolled in T-COACH and were linked to the National Cancer Registry database for the development of 12 extrahepatic malignancies, including those with potential associations with HCV and with the top-ranking incidence in Taiwan, over a median follow-up period was 3.79 years (range, 0-16.44 years).
RESULTS
During the 44,354 person-years of follow-up, 324 (3.02%) patients developed extrahepatic malignancies, without a difference between patients with and without SVR (annual incidence: 0.69% vs 0.87%, respectively). Compared with patients with SVR, patients without SVR had a significantly higher risk of gastric cancer (0.10% vs 0.03% per person-year, P = 0.004) and non-Hodgkin lymphoma (NHL) (0.08% vs 0.03% per person-year, respectively, P = 0.03). When considering death as a competing risk, non-SVR was independently associated with gastric cancer (hazard ratio [HR]/95% confidence intervals [CIs]: 3.29/1.37-7.93, P = 0.008). When patients were stratified by age, the effect of SVR in reducing gastric cancer (HR/CI: 0.30/0.11-0.83) and NHL (HR/CI: 0.28/0.09-0.85) was noted only in patients aged <65 years but not those aged >65 years.
DISCUSSION
HCV eradication reduced the risk of gastric cancer and NHL, in particular among younger patients, indicating that patients with chronic hepatitis C should be treated as early as possible.
简介
慢性丙型肝炎病毒（HCV）感染与非肝细胞癌恶性肿瘤有关。我们旨在评估在真实世界的全台湾慢性丙型肝炎队列（T-COACH）中，实现持续病毒学应答（SVR，定义为治疗后 24 周随访期间 HCV RNA 血清阴性）是否可以降低非肝细胞癌恶性肿瘤的风险。
方法
共有 10714 名接受干扰素为基础治疗的慢性丙型肝炎患者（8186 名 SVR 和 2528 名非 SVR）入组 T-COACH，并与国家癌症登记数据库相关联，以发现 12 种肝外恶性肿瘤，包括与 HCV 有潜在关联且在台湾发病率最高的恶性肿瘤，中位随访时间为 3.79 年（范围为 0-16.44 年）。
结果
在 44354 人年的随访期间，324 名（3.02%）患者发生了肝外恶性肿瘤，SVR 患者和非 SVR 患者之间无差异（年发生率：分别为 0.69%和 0.87%）。与 SVR 患者相比，非 SVR 患者患胃癌的风险显著更高（0.10% vs 0.03%/人年，P=0.004）和非霍奇金淋巴瘤（NHL）（0.08% vs 0.03%/人年，分别，P=0.03）。当考虑死亡为竞争风险时，非 SVR 与胃癌独立相关（风险比[HR]/95%置信区间[CI]：3.29/1.37-7.93，P=0.008）。当按年龄分层患者时，SVR 降低胃癌（HR/CI：0.30/0.11-0.83）和 NHL（HR/CI：0.28/0.09-0.85）的作用仅在年龄<65 岁的患者中观察到，但在年龄>65 岁的患者中则不然。
讨论
HCV 清除降低了胃癌和 NHL 的风险，尤其是在年轻患者中，这表明慢性丙型肝炎患者应尽早治疗。
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