Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan.
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
J Viral Hepat. 2020 Sep;27(9):873-879. doi: 10.1111/jvh.13302. Epub 2020 May 14.
No guidelines have been developed for the management of HCV-infected cancer patients receiving chemotherapy. The current study aimed to investigate the incidence of severe acute exacerbation of HCV infection in cancer patients receiving chemotherapy and to search for risk factors predicting severe acute exacerbation of HCV infection. This retrospective cohort study reviewed the clinical data of the cancer patients receiving chemotherapy in our institute from August 2012 to December 2017. Incidences of severe acute exacerbation of HCV infection in different kinds of cancers were assessed, and risk factors were analysed. Cancer patients with HCV infection (n = 306) had a higher frequency of severe acute liver injury (2.3% vs 0.7%; P = .003) than those without HCV infection (n = 4419). The incidence of severe acute exacerbation in HCV-infected haematological cancer patients was higher than that in those with HCC and non-HCC solid tumours (9.4% vs 1.9% and 1.1%). Rituximab-containing chemotherapy and haematological malignancy were the risk factors related to the acute exacerbation (P < .001 and P = .004, respectively). None of the patients with severe acute HCV flares developed hepatic decompensation or mortality. However, 57.1% of them discontinued chemotherapy due to liver dysfunction. In conclusion, HCV infection increases the risk of acute severe liver injury in cancer patients undergoing chemotherapy. Rituximab-containing chemotherapy and haematological malignancy are the risk factors related to severe acute exacerbation of HCV infection in cancer patients undergoing chemotherapy. Pre-chemotherapy HCV testing is therefore mandatory before rituximab-containing chemotherapy for the treatment of haematological malignancy.
目前尚无针对接受化疗的 HCV 感染癌症患者的管理指南。本研究旨在调查接受化疗的癌症患者中 HCV 感染严重急性加重的发生率，并寻找预测 HCV 感染严重急性加重的危险因素。这项回顾性队列研究回顾了 2012 年 8 月至 2017 年 12 月在我院接受化疗的癌症患者的临床数据。评估了不同类型癌症中 HCV 感染严重急性加重的发生率，并分析了危险因素。与未感染 HCV 的癌症患者（n=4419）相比，感染 HCV 的癌症患者（n=306）发生严重急性肝损伤的频率更高（2.3%比 0.7%；P=0.003）。HCV 感染血液系统恶性肿瘤患者发生严重急性加重的发生率高于 HCC 和非 HCC 实体瘤患者（9.4%比 1.9%和 1.1%）。含利妥昔单抗的化疗和血液系统恶性肿瘤是与急性加重相关的危险因素（P<0.001 和 P=0.004）。没有严重 HCV 发作的患者发生肝失代偿或死亡。然而，由于肝功能障碍，他们中有 57.1%的人停止了化疗。总之，HCV 感染增加了接受化疗的癌症患者发生急性严重肝损伤的风险。含利妥昔单抗的化疗和血液系统恶性肿瘤是接受化疗的癌症患者发生 HCV 感染严重急性加重的危险因素。因此，对于血液恶性肿瘤的利妥昔单抗治疗，在化疗前必须进行 HCV 检测。
