Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2021 Mar;36(2):292-304. doi: 10.3904/kjim.2019.297. Epub 2020 Apr 3.
BACKGROUND/AIMS: Chronic hepatitis C (CHC) treatment has dramatically improved since direct-acting antiviral (DAA) therapy was introduced. However, the use of DAA therapy in CHC patients with hepatocellular carcinoma (HCC) remains controversial. We investigated the DAA treatment response in CHC patients with HCC.
We retrospectively analyzed CHC patients treated with DAA from 2016 to 2018. Patients were divided into two groups based on their HCC-history before DAA therapy. Baseline characteristics, sustained virologic response at 12 weeks (SVR 12), and HCC recurrence after DAA therapy were evaluated. We also used propensity score matching (PSM) in a 2:1 ratio to reduce confounding variables.
A total of 192 patients were enrolled; 78.1% were treatment-naïve, and 34.9% had liver cirrhosis (LC). Among these patients, 168 did not have HCC, and 24 had HCC. The HCC group was older (57.0 years vs. 72.0 years, p < 0.001), had a higher incidence of LC (26.2% vs. 95.8%, p < 0.001), fibrosis-4 index (2.6 vs. 9.2, p < 0.001), liver stiffness measurement (7.0 kPa vs. 17.4 kPa, p = 0.012), and α-fetoprotein (4.4 ng/mL vs. 8.2 ng/mL, p ≤ 0.001). The SVR 12 rate was 97.0% in the non- HCC group and 91.7% in the HCC group (p = 0.213). HCC recurrence was observed in 14 patients (58.3%) in the HCC group.
DAA treatment efficacy in CHC patients with or those without HCC were not significantly different, and HCC recurrence was relatively common.
背景/目的：自直接作用抗病毒 (DAA) 疗法问世以来，慢性丙型肝炎 (CHC) 的治疗已取得显著进展。然而，DAA 疗法在合并肝细胞癌 (HCC) 的 CHC 患者中的应用仍存在争议。本研究旨在探究 DAA 治疗合并 HCC 的 CHC 患者的应答情况。
我们回顾性分析了 2016 年至 2018 年接受 DAA 治疗的 CHC 患者。根据 DAA 治疗前的 HCC 病史，将患者分为两组。评估两组患者的基线特征、12 周持续病毒学应答 (SVR12) 和 DAA 治疗后的 HCC 复发情况。我们还使用倾向评分匹配（PSM）进行 2:1 配比，以减少混杂变量。
共纳入 192 例患者；78.1%为初治患者，34.9%存在肝硬化 (LC)。其中，168 例患者无 HCC，24 例患者存在 HCC。HCC 组患者年龄较大（57.0 岁比 72.0 岁，p<0.001），LC 发生率较高（26.2%比 95.8%，p<0.001），纤维化-4 指数（2.6 比 9.2，p<0.001）、肝脏硬度测量值（7.0 kPa 比 17.4 kPa，p=0.012）和甲胎蛋白（4.4 ng/mL 比 8.2 ng/mL，p≤0.001）较高。非 HCC 组和 HCC 组的 SVR12 率分别为 97.0%和 91.7%（p=0.213）。HCC 组有 14 例患者（58.3%）发生 HCC 复发。
合并或不合并 HCC 的 CHC 患者的 DAA 治疗效果无显著差异，且 HCC 复发较为常见。
