Center for Drug Evaluation and Safety, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Aliment Pharmacol Ther. 2020 Nov;52(10):1592-1602. doi: 10.1111/apt.16081. Epub 2020 Sep 15.
Hepatitis C virus (HCV) infection is associated with with an increased risk of non-hepatic cancers, but the impact of HCV treatment on non-hepatic cancer is unclear.
To assess if HCV treatment reduced the incidence of non-hepatic cancers among patients with chronic HCV infection in the US.
We conducted a retrospective cohort study in MarketScan Databases from January 2005 to December 2016. Multivariable, time-varying Cox proportional-hazards models were used to determine hazard ratios (HRs) of incident non-hepatic cancers in treated and untreated patients with HCV infection. We conduscted subgroup analyses for sex, age, and presence of cirrhosis or diabetes.
Among 62 078 patients with newly diagnosed HCV infection, 17 302 (28%) initiated HCV treatment, among whom 15 322 completed 8-16 weeks treatment (minimally effective treatment). Patients who initiated HCV treatment had an 11% decreased risk of developing an incident non-hepatic cancer compared to untreated patients (HR = 0.89, 95% confidence interval (Cl) = 0.82-0.96). The reduction was slightly higher when patients completed a minimally effective treatment (HR = 0.87; 95% Cl = 0.80 - 0.95). This was observed in most subgroup analyses for those who had a minimally effective treatment including patients with cirrhosis. When we stratified cancer or therapy subtypes, the association remained consistent for pancreatic and lung cancers, and dual HCV therapy.
HCV treatment led to a significantly reduced incidence of non-hepatic cancers among patients with HCV infection. Despite discrepancies between cancer or HCV therapy subtypes, our findings suggest that treating HCV infection can decrease the extrahepatic cancer burden associated with chronic HCV infection.
丙型肝炎病毒（HCV）感染与非肝脏癌症的风险增加相关，但 HCV 治疗对非肝脏癌症的影响尚不清楚。
评估美国慢性 HCV 感染患者接受 HCV 治疗是否降低了非肝脏癌症的发病率。
我们在 2005 年 1 月至 2016 年 12 月的 MarketScan 数据库中进行了一项回顾性队列研究。使用多变量、时变 Cox 比例风险模型来确定治疗和未治疗 HCV 感染患者新发非肝脏癌症的风险比（HR）。我们对性别、年龄、肝硬化或糖尿病的存在进行了亚组分析。
在 62078 例新诊断的 HCV 感染患者中，有 17302 例（28%）开始接受 HCV 治疗，其中 15322 例完成了 8-16 周的治疗（最小有效治疗）。与未治疗的患者相比，开始 HCV 治疗的患者发生新发非肝脏癌症的风险降低了 11%（HR=0.89，95%置信区间[CI]：0.82-0.96）。当患者完成最小有效治疗时，这种降低幅度略高（HR=0.87；95%CI：0.80-0.95）。在大多数对完成最小有效治疗的患者进行的亚组分析中都观察到了这一结果，包括肝硬化患者。当我们对癌症或 HCV 治疗亚型进行分层时，这种关联在胰腺癌和肺癌以及双重 HCV 治疗中仍然一致。
HCV 治疗可显著降低 HCV 感染患者非肝脏癌症的发病率。尽管癌症或 HCV 治疗亚型存在差异，但我们的研究结果表明，治疗 HCV 感染可以降低与慢性 HCV 感染相关的非肝脏癌症负担。
