直接作用抗病毒药物可改善介入肿瘤科丙型肝炎和肝细胞癌患者的总生存率。
Direct-Acting Antivirals Improve Overall Survival in Interventional Oncology Patients with Hepatitis C and Hepatocellular Carcinoma.
机构信息
Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510.
Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510.
出版信息
J Vasc Interv Radiol. 2020 Jun;31(6):953-960. doi: 10.1016/j.jvir.2019.12.809. Epub 2020 May 4.
PURPOSE
To investigate the impact of direct-acting antivirals (DAAs) and 12-week sustained virologic response (SVR12) in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) treated by interventional oncology (IO) therapies.
MATERIALS AND METHODS
Retrospective analysis of patients diagnosed from 2005 to 2016 with HCC and receiving IO therapies. A total of 478 patients met inclusion criteria. Patients were age 29-90 years (mean 63.6 ± 9.4 years) and 78.9% (n =3 77) male. Two hundred and eighty-five (57%) patients had chronic HCV, 93 (33%) received DAAs, and 63 (68%) achieved SVR12. Liver function, tumor characteristics, and IO therapy including ablation, image-guided transcatheter tumor therapies (ITTT) (eg, chemoembolization and radioembolization), and combination locoregional therapy were assessed in analysis.
RESULTS
Median overall survival (OS) of the cohort was 26.7 months (95% confidence interval [CI] 21.9-29.9). OS for ablation, combination locoregional therapy and ITTT, was 37.3 (CI 30.7-49.9), 29.3 (CI 24.2-38.0), and 19.7 months (CI 16.5-22.8), respectively (P < .0001). OS in patients with HCV was 30.7 months (CI 24.2-35.2) versus 22.2 months in non-HCV patients (CI 17.8-27.8, P = .03). Patients with HCV who received DAA had higher survival, 49.2 months (CI 36.5-not reached) versus those not receiving DAA, 18.5 months (CI 14.1-25.3, P < .0001). OS was 71.8 months (CI 42.3-not reached) for patients who achieved SVR12 after DAA versus 26.7 months in the non-SVR12 group (CI 15.9-31.1, P < .0001). Multivariable analysis revealed independent factors for OS including IO treatment type, DAA use and achieving SVR12 (P < .05).
CONCLUSIONS
DAA use and SVR12 is associated with higher OS in patients with HCV-related HCC treated by IO therapies.
目的
研究直接作用抗病毒药物（DAAs）和 12 周持续病毒学应答（SVR12）对接受介入肿瘤学（IO）治疗的丙型肝炎病毒（HCV）相关肝细胞癌（HCC）患者的影响。
材料和方法
回顾性分析 2005 年至 2016 年间诊断为 HCC 并接受 IO 治疗的患者。共有 478 名患者符合纳入标准。患者年龄 29-90 岁（平均 63.6±9.4 岁），78.9%（n=377）为男性。285 名（57%）患者患有慢性 HCV，93 名（33%）接受了 DAA 治疗，63 名（68%）达到了 SVR12。在分析中评估了肝功能、肿瘤特征以及 IO 治疗，包括消融、影像引导经导管肿瘤治疗（ITT）（如化疗栓塞和放射性栓塞）以及局部区域联合治疗。
结果
该队列的中位总生存期（OS）为 26.7 个月（95%置信区间 [CI] 21.9-29.9）。消融、联合局部区域治疗和 ITTT 的 OS 分别为 37.3 个月（CI 30.7-49.9）、29.3 个月（CI 24.2-38.0）和 19.7 个月（CI 16.5-22.8）（P<.0001）。HCV 患者的 OS 为 30.7 个月（CI 24.2-35.2），而非 HCV 患者为 22.2 个月（CI 17.8-27.8，P=0.03）。接受 DAA 治疗的 HCV 患者的生存率更高，为 49.2 个月（CI 36.5-未达到），而未接受 DAA 治疗的患者为 18.5 个月（CI 14.1-25.3，P<.0001）。接受 DAA 治疗后达到 SVR12 的患者的 OS 为 71.8 个月（CI 42.3-未达到），而非 SVR12 组为 26.7 个月（CI 15.9-31.1，P<.0001）。多变量分析显示，OS 的独立影响因素包括 IO 治疗类型、DAA 使用和达到 SVR12（P<.05）。
结论
在接受 IO 治疗的 HCV 相关 HCC 患者中，DAA 使用和 SVR12 与更高的 OS 相关。
Zotero 插件