Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Surg Oncol. 2020 Dec;122(8):1543-1552. doi: 10.1002/jso.26184. Epub 2020 Aug 27.
To investigate the postoperative recurrence of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after liver resection in patients with and without the achievement of sustained virologic response (SVR) through the administration of direct-acting antivirals (DAA).
Among 28 patients with HCC detected after DAA-SVR (DAA group) and 197 patients with HCC who did not receive treatment for HCV infection or who did not achieve an SVR (control group) between January 2000 and July 2019, we performed propensity score matching (PSM) to avoid confounding differences between the two groups.
After PSM, 28 patients in each group were selected for analysis. The DAA-SVR patients showed improved liver function at operation and at recurrence in comparison to the control group. The disease-free survival rate at 3 years after surgery was 69% in the DAA group and 35% in the control group, respectively (P = .021). In the DAA group, all three patients with recurrence met the Milan criteria and could be managed by curative treatments and none died of liver failure during the follow-up period.
SVR status suppresses postoperative recurrence of HCV-related HCC detected after DAA-SVR. Improved liver function may contribute to the successful treatment and prevention of liver failure.
通过直接作用抗病毒药物（DAA）的治疗，调查在达到持续病毒学应答（SVR）和未达到 SVR 的丙型肝炎病毒（HCV）相关肝细胞癌（HCC）患者中，肝切除术后 HCV 相关 HCC 术后复发的情况。
在 2000 年 1 月至 2019 年 7 月期间，我们发现了 28 例接受 DAA-SVR 后 HCC（DAA 组）和 197 例未接受 HCV 感染治疗或未达到 SVR 的 HCC 患者（对照组），我们进行了倾向评分匹配（PSM）以避免两组之间存在混杂差异。
经过 PSM，每组各选择 28 例患者进行分析。与对照组相比，DAA-SVR 患者在手术和复发时肝功能有所改善。DAA 组术后 3 年无疾病生存率为 69%，对照组为 35%（P=0.021）。在 DAA 组中，所有 3 例复发患者均符合米兰标准，可以通过根治性治疗进行管理，并且在随访期间没有因肝功能衰竭而死亡。
SVR 状态抑制了 DAA-SVR 后 HCV 相关 HCC 的术后复发。肝功能的改善可能有助于成功治疗和预防肝功能衰竭。
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