Hepatology Unit, Hôpital Cochin, AP-HP, 27, rue du Fg Saint-Jacques, 75014 Paris, France.
Radiologie Hôpital Necker AP-HP, Paris, France.
Clin Res Hepatol Gastroenterol. 2021 Jan;45(1):101459. doi: 10.1016/j.clinre.2020.04.022. Epub 2020 Jun 25.
Although it has now been excluded that direct-acting antivirals (DAA) are associated with a significant risk of hepatocellular carcinoma (HCC) in HCV-infected patients, a possible effect of DAA on tumor growth is still a subject of debate. We performed a blind comparison of the kinetics of HCC recurrence in patients after HCV treatment with or without DAA to evaluate the potential aggressiveness of HCC after DAA treatment.
Thirty-nine HCV-infected patients from the AFEF/ANRS CO22 Hepather cohort who experienced HCC recurrence after so-called curative treatment were evaluated. Contrast-enhanced CT and/or MR images were read blindly 6 months before HCC recurrence and during the follow-up period. Seventeen patients who received DAA (DAA+) before HCC recurrence were compared to the 22 who did not receive (DAA-), according to the LiRads and mRECIST criteria.
There were 28 men and 11 women, median age 62 years old, 37 (95%) with cirrhosis. DAA+ patients had a lower median MELD score (8±2 vs. 10±4, P=0.0286) than DAA- patients. The median time to HCC recurrence (time from the date of curative treatment to the diagnosis of recurrence) was not different (20 vs. 18 months) (P=0.73) between the two groups. There was no difference between the 2 groups in the overall survival and/or transplantation-free survival (P=0.71) and for the mRECIST time to progression (P=0.25).
This blinded analysis of HCC recurrence after HCC treatment does not support any negative impact of DAA therapy on the severity or progression of recurrent HCC.
虽然现在已经排除了直接作用抗病毒药物（DAA）在 HCV 感染患者中与肝细胞癌（HCC）发生的显著风险相关，但 DAA 对肿瘤生长的可能影响仍存在争议。我们对 HCV 治疗后有或无 DAA 的 HCC 复发患者的 HCC 复发动力学进行了盲法比较，以评估 DAA 治疗后 HCC 的潜在侵袭性。
从 AFEF/ANRS CO22 Hepather 队列中评估了 39 例 HCV 感染患者，这些患者在所谓的治愈性治疗后经历了 HCC 复发。在 HCC 复发前 6 个月和随访期间，对增强 CT 和/或 MR 图像进行了盲法阅读。根据 LiRads 和 mRECIST 标准，将 17 例在 HCC 复发前接受 DAA（DAA+）的患者与 22 例未接受 DAA（DAA-）的患者进行了比较。
有 28 名男性和 11 名女性，中位年龄 62 岁，37 例（95%）有肝硬化。DAA+患者的中位 MELD 评分较低（8±2 与 10±4，P=0.0286）。两组 HCC 复发的中位时间（从治愈性治疗到复发的诊断）无差异（20 与 18 个月）（P=0.73）。两组之间的总生存和/或无移植生存（P=0.71）和 mRECIST 进展时间（P=0.25）均无差异。
这项 HCC 治疗后 HCC 复发的盲法分析不支持 DAA 治疗对复发性 HCC 的严重程度或进展有任何负面影响。
