Khalid Javeria, Umar Mohammad, Ur-Rehman Tofeeq, Ali Mashhood, Khan Gul Majid
Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320 Pakistan.
Clinical Pharmacist at Shifa International Hospital Islamabad, Islamabad, Pakistan.
Infect Agent Cancer. 2020 May 27;15:35. doi: 10.1186/s13027-020-00300-z. eCollection 2020.
Hepatitis C virus (HCV) represents a major risk factor for hepatocellular carcinoma (HCC) development and anti-HCV therapy is a significant measure to reduce the incidence of HCC, however development of HCC in HCV treated patients is an emerging clinical problem which needs to be investigated. In this study we aim to analyze association between anti-HCV therapy and tumor pattern of HCV related HCC patients.
Hepatocellular Carcinoma (HCC) patients with seropositivity for hepatitis C virus (HCV) antibodies, registered at three tertiary care hospitals of Rawalpindi and Islamabad, Pakistan during August 2017 to July 2018 were enrolled. Selected patients were then segregated in two groups on the basis of their HCV treatment history i.e., "TN" (HCV Treatment Naïve i.e. having no history/medical record for treatment prior to HCC diagnosis) and "TH" (Treated for HCV infection). Aggressiveness index (AgI) scoring system was applied to determine the tumor pattern. Univariate and multivariate analysis was carried out to analyze the independent effect of anti-HCV therapy on tumor pattern.
Out of 234 consecutive HCC patients, 171 HCV-related HCC patients were enrolled in final analysis and labeled as "TN" ( = 120) and "TH" ( = 51). Tumor pattern was found to be significantly aggressive ( = 0.02) in the treated cohort with an adjusted odds of 2.47 for aggressive and 6.92 for highly aggressive tumor. Neutrophil to lymphocyte ratio (NLR) was strongly associated with highly aggressive tumor pattern ( = 0.012). Patients in TN group were found to be marginally older than those in the TH group (59.5 vs. 55 years) where mean age of the patients treated with direct acting anti-viral agents was found to be visibly lower than mean age of patients who received interferon based treatment (53.5 vs. 57 years) with significant masculine predominance (62.1 vs. 37.9%, = 0.049).
We observed raised neutrophil to lymphocyte ratio and prominence of younger age with aggressive tumor biology in HCV treated HCC patients. These observations highlight the need for a longitudinal prospective study on HCV positive subjects treated with antivirals, irrespective of treatment response.
丙型肝炎病毒（HCV）是肝细胞癌（HCC）发生的主要危险因素，抗HCV治疗是降低HCC发病率的一项重要措施，然而，接受HCV治疗的患者发生HCC是一个新出现的临床问题，需要进行研究。在本研究中，我们旨在分析抗HCV治疗与HCV相关HCC患者肿瘤模式之间的关联。
纳入2017年8月至2018年7月期间在巴基斯坦拉瓦尔品第和伊斯兰堡的三家三级医疗机构登记的丙型肝炎病毒（HCV）抗体血清学阳性的肝细胞癌（HCC）患者。然后根据患者的HCV治疗史将选定的患者分为两组，即“TN”（未接受过HCV治疗，即HCC诊断前无治疗史/病历）和“TH”（接受过HCV感染治疗）。应用侵袭性指数（AgI）评分系统确定肿瘤模式。进行单因素和多因素分析以分析抗HCV治疗对肿瘤模式的独立影响。
在234例连续的HCC患者中，171例HCV相关HCC患者纳入最终分析，并分为“TN”组（n = 120）和“TH”组（n = 51）。在接受治疗的队列中，肿瘤模式被发现具有显著侵袭性（P = 0.02），侵袭性肿瘤的调整比值为2.47，高度侵袭性肿瘤的调整比值为6.92。中性粒细胞与淋巴细胞比值（NLR）与高度侵袭性肿瘤模式密切相关（P = 0.012）。发现TN组患者的年龄略大于TH组患者（59.5岁对55岁），其中接受直接抗病毒药物治疗的患者平均年龄明显低于接受基于干扰素治疗的患者（53.5岁对57岁），男性占主导地位（62.1%对37.9%，P = 0.049）。
我们观察到接受HCV治疗的HCC患者中性粒细胞与淋巴细胞比值升高，且年龄较轻，肿瘤生物学行为具有侵袭性。这些观察结果突出表明，需要对接受抗病毒治疗的HCV阳性受试者进行纵向前瞻性研究，无论治疗反应如何。
