Okamura Yukiyasu, Sugiura Teiichi, Ito Takaaki, Yamamoto Yusuke, Ashida Ryo, Ohgi Katsuhisa, Ohtsuka Shimpei, Aramaki Takeshi, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.
Division of Interventional Radiology Shizuoka Cancer Center Hospital Shizuoka Japan.
Ann Gastroenterol Surg. 2021 Feb 27;5(4):553-566. doi: 10.1002/ags3.12451. eCollection 2021 Jul.
Hepatitis C virus (HCV) infection is a major cause of hepatocellular carcinoma (HCC) in Japan. However, the cause and prognosis of HCC may be dramatically changed by direct acting antiviral agents (DAAs). Although the 2015 nationwide survey used a large cohort, its findings may be outdated. The present study therefore aimed to show the latest outcomes by patients' hepatitis virus infection status.
We included 552 patients who underwent hepatectomy for primary HCC between 2002 and 2018 and compared clinical factors between those treated before 2014 (n = 380) and after 2014 (n = 172), when DAAs became available.
Distribution of hepatitis virus infection status between the two groups differed significantly ( < 0.001). In the earlier group, 46% of the patients had HCC with HCV infection (C-HCC), whereas the rate of C-HCC decreased (31%) and 54% of the patients had HCC with no hepatitis virus infection (NBNC-HCC) in the latter group. The proportion of HCC with hepatitis B virus infection (B-HCC) and the prognosis of B-HCC did not significantly change between the two groups. Among patients with C-HCC, the latter patients had significantly longer relapse-free survival (RFS) than the earlier patients ( = 0.033). However, RFS did not significantly differ between the earlier and latter patients with NBNC-HCC.
Postoperative prognosis has changed according to patients' hepatitis virus infection status. The proportion of patients with NBNC-HCC has increased, but their prognosis has not been improved. Treatment strategies for NBNC-HCC should be established.
在日本，丙型肝炎病毒（HCV）感染是肝细胞癌（HCC）的主要病因。然而，直接抗病毒药物（DAAs）可能会显著改变HCC的病因和预后。尽管2015年的全国性调查采用了大型队列研究，但其结果可能已过时。因此，本研究旨在展示患者肝炎病毒感染状态的最新结果。
我们纳入了2002年至2018年间因原发性HCC接受肝切除术的552例患者，并比较了2014年之前（n = 380）和2014年之后（n = 172）接受治疗的患者的临床因素，2014年之后DAAs开始可用。
两组之间肝炎病毒感染状态的分布存在显著差异（<0.001）。在较早的组中，46%的患者患有HCV感染的HCC（C-HCC），而在较晚的组中，C-HCC的比例下降（31%），54%的患者患有无肝炎病毒感染的HCC（NBNC-HCC）。两组之间乙型肝炎病毒感染的HCC（B-HCC）比例和B-HCC的预后没有显著变化。在C-HCC患者中，较晚的患者无复发生存期（RFS）明显长于较早的患者（=0.033）。然而，NBNC-HCC的较早和较晚患者之间的RFS没有显著差异。
术后预后根据患者的肝炎病毒感染状态发生了变化。NBNC-HCC患者的比例有所增加，但其预后并未改善。应制定NBNC-HCC的治疗策略。
