Takakusagi Satoshi, Takagi Hitoshi, Kosone Takashi, Sato Ken, Kakizaki Satoru, Uraoka Toshio
Department of Gastroenterology and Hepatology Kusunoki Hospital Fujioka Japan.
Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Maebashi Japan.
JGH Open. 2020 Nov 23;5(1):122-127. doi: 10.1002/jgh3.12459. eCollection 2021 Jan.
We investigated the prognosis of late elderly patients (≥75 years old) after the achievement of a sustained viral response (SVR) by direct-acting antivirals (DAAs).
One hundred and four late elderly patients and 251 young patients (≤74 years old) who had achieved an SVR were included. We compared the cumulative hepatocellular carcinoma (HCC) incidence rates and survival rates after DAA administration. Furthermore, the factors associated with HCC incidence and the causes of death after DAA administration were also investigated.
The cumulative HCC incidence rates for 1 and 3 years were 2.9% and 11.7% in the late elderly patients and 2.4% and 5.4% in the young patients, respectively. The cumulative survival rates for 1 and 3 years were 100% and 95.6% in the late elderly patients and 100% and 96.4% in the young patients, respectively, with no significant differences in those rates noted ( = 0.133, = 0.322, respectively). In the late elderly patients, only a history of HCC was a significant factor associated with HCC incidence after DAA administration. Five late elderly patients died after achieving an SVR, and malignant liver tumor was the cause of death in three of those patients.
The prognosis did not differ markedly between late elderly patients and young patients. The factor most strongly influencing the prognosis of late elderly patients was likely liver disease, including HCC. DAAs should be introduced even in late elderly patients who can be expected to have a relative long-term survival.
我们研究了老年晚期患者（≥75岁）在通过直接抗病毒药物（DAA）实现持续病毒学应答（SVR）后的预后情况。
纳入了104例实现SVR的老年晚期患者和251例年轻患者（≤74岁）。我们比较了DAA治疗后肝细胞癌（HCC）的累积发病率和生存率。此外，还研究了与HCC发病相关的因素以及DAA治疗后的死亡原因。
老年晚期患者1年和3年的HCC累积发病率分别为2.9%和11.7%，年轻患者分别为2.4%和5.4%。老年晚期患者1年和3年的累积生存率分别为100%和95.6%，年轻患者分别为100%和96.4%，这些比率无显著差异（分别为 = 0.133， = 0.322）。在老年晚期患者中，只有HCC病史是DAA治疗后与HCC发病相关的显著因素。5例老年晚期患者在实现SVR后死亡，其中3例患者的死亡原因是恶性肝肿瘤。
老年晚期患者和年轻患者的预后没有明显差异。最强烈影响老年晚期患者预后的因素可能是肝脏疾病，包括HCC。即使是预期有相对长期生存的老年晚期患者，也应使用DAA。
