Nagaoki Yuko, Imamura Michio, Teraoka Yuji, Morio Kei, Fujino Hatsue, Ono Atsushi, Nakahara Takashi, Murakami Eisuke, Yamauchi Masami, Kawaoka Tomokazu, Miki Daiki, Tsuge Masataka, Hiramatsu Akira, Hayes C Nelson, Chayama Kazuaki, Aikata Hiroshi
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan.
Hepatol Res. 2020 Nov;50(11):1222-1233. doi: 10.1111/hepr.13554. Epub 2020 Sep 7.
We analyzed the impact of hepatitis C virus eradication by direct-acting antiviral (DAA) therapy on the risk of development of hepatocellular carcinoma (HCC), prognosis, and portal hypertension in patients with liver cirrhosis.
The rate of HCC development and overall survival after achievement of sustained virological response (SVR) in 173 DAA-treated compensated cirrhosis patients without HCC history were retrospectively compared with that of 125 cirrhosis patients who achieved SVR by interferon (IFN)-based therapy or that of 85 cirrhosis patients who failed to respond to anti-HCV therapy. Changes in esophagogastric varices (EGV) and incidence of portosystemic encephalopathy were analyzed in 87 consecutive cirrhosis patients.
The cumulative HCC development rates at 1, 3, and 5 years were 2%, 7%, and 7% for the DAA-SVR group, significantly lower than the 3%, 7%, and 18% for the non-SVR group (log-rank, P < 0.001). The cumulative overall survival rates were also significantly improved in the DAA-SVR group compared to the non-SVR group (log-rank, P < 0.001). These rates were similar between DAA-SVR and IFN-SVR groups (P = 0.121 and 0.261, respectively). Esophagogastric varices were aggravated, and portosystemic encephalopathy occurred in a subset of cirrhosis patients who achieved SVR by DAA therapy. These events were more frequent in patients with large feeding vessels for EGV and portosystemic shunts at the time of SVR.
Achievement of SVR by DAA therapy reduces the risk of HCC development and prolongs survival, similar to theresults achieved with IFN-based therapy, but portal hypertension is not immediately improved in compensated liver cirrhosis patients.
我们分析了直接抗病毒（DAA）疗法根除丙型肝炎病毒对肝硬化患者肝细胞癌（HCC）发生风险、预后及门静脉高压的影响。
回顾性比较173例接受DAA治疗且无HCC病史的代偿期肝硬化患者实现持续病毒学应答（SVR）后的HCC发生率及总生存率，与125例通过基于干扰素（IFN）的疗法实现SVR的肝硬化患者以及85例抗HCV治疗无应答的肝硬化患者进行比较。对87例连续的肝硬化患者分析食管胃静脉曲张（EGV）变化及门体性脑病发生率。
DAA-SVR组1年、3年和5年的累积HCC发生率分别为2%、7%和7%，显著低于非SVR组的3%、7%和18%（对数秩检验，P<0.001）。与非SVR组相比，DAA-SVR组的累积总生存率也显著提高（对数秩检验，P<0.001）。DAA-SVR组和IFN-SVR组之间这些比率相似（分别为P=0.121和0.261）。DAA治疗实现SVR的部分肝硬化患者中，食管胃静脉曲张加重，出现门体性脑病。这些事件在SVR时存在EGV粗大供血血管和门体分流的患者中更常见。
DAA疗法实现SVR可降低HCC发生风险并延长生存期，与基于IFN的疗法效果相似，但代偿期肝硬化患者的门静脉高压不会立即改善。
