St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
St Vincent's Hospital, Sydney, NSW, Australia.
J Viral Hepat. 2021 May;28(5):710-718. doi: 10.1111/jvh.13475. Epub 2021 Feb 2.
The impact of hepatitis C virus (HCV) cure on survival in patients with HCV-related hepatocellular carcinoma (HCC) has been examined, although many studies have been subject to survivor treatment selection bias. We assessed the impact of HCV cure before HCC diagnosis on overall survival. Patients with HCV-related HCC at three referral hospitals in Australia were included retrospectively (January 2008 to December 2019). The risk of death following HCC diagnosis among patients who achieved HCV cure before HCC diagnosis was compared to patients who were viraemic at diagnosis. Among 422 patients with HCV-related HCC, 101 (24%) achieved HCV cure before HCC diagnosis, 37 with interferon (IFN) and 64 with direct-acting antiviral (DAA) therapy. Patients with HCV cure were more likely to have no cirrhosis or Child-Pugh A liver disease (83% vs. 66%, p = .002), surveillance detection (71% vs. 48%, p < .001), HCC stage O or A (64% vs. 45%, p < .001) and receive curative initial HCC management (51% vs. 28%, p < .001), compared with patients who were viraemic at diagnosis. The 5-year overall survival was 51% in the HCV cure group and 22% in the viraemic group. In adjusted analysis, risk of death was lower in patients with HCV cure before HCC diagnosis compared with patients who were viraemic at diagnosis (adjusted hazard ratio: 0.63; 95% CI: 0.44-0.91; p = .013). Patients with HCV-related HCC who have achieved HCV cure before HCC diagnosis have improved overall survival compared with patients who were viraemic at diagnosis.
已研究了丙型肝炎病毒 (HCV) 治愈对 HCV 相关肝细胞癌 (HCC) 患者生存的影响，尽管许多研究都受到幸存者治疗选择偏倚的影响。我们评估了 HCC 诊断前 HCV 治愈对总生存的影响。澳大利亚三家转诊医院回顾性纳入了 HCV 相关 HCC 患者（2008 年 1 月至 2019 年 12 月）。比较了 HCC 诊断前实现 HCV 治愈患者与诊断时病毒血症患者在 HCC 诊断后死亡的风险。在 422 例 HCV 相关 HCC 患者中，101 例（24%）在 HCC 诊断前实现了 HCV 治愈，其中 37 例接受了干扰素 (IFN) 治疗，64 例接受了直接作用抗病毒 (DAA) 治疗。与诊断时病毒血症患者相比，实现 HCV 治愈的患者更有可能没有肝硬化或 Child-Pugh A 级肝病（83%比 66%，p=0.002）、接受监测检测（71%比 48%，p<0.001）、HCC 分期为 O 期或 A 期（64%比 45%，p<0.001）和接受根治性初始 HCC 治疗（51%比 28%，p<0.001）。HCV 治愈组的 5 年总生存率为 51%，病毒血症组为 22%。在调整分析中，与诊断时病毒血症患者相比，HCC 诊断前实现 HCV 治愈的患者死亡风险较低（调整后的危险比：0.63；95%置信区间：0.44-0.91；p=0.013）。与诊断时病毒血症患者相比，在 HCC 诊断前已实现 HCV 治愈的 HCV 相关 HCC 患者总体生存率更高。
