Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy; Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Sicilia, Italy.
Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
Ann Hepatol. 2022 Jan;27 Suppl 1:100568. doi: 10.1016/j.aohep.2021.100568. Epub 2021 Oct 23.
Direct-acting antivirals (DAAs) revolutionized the treatment of chronic HCV-related disease achieving high rates of sustained virological response (SVR), even in advanced cirrhosis, with modest contraindications and a low rate of adverse events. However, the risk of hepatocellular carcinoma (HCC) persists due to the underlying chronic liver disease, both in patients with and without history of HCC. Although some initial studies reported a presumptive high risk of HCC development after DAA therapy, more recent observational studies denied this hypothesis. The residual risk for HCC occurrence after HCV eradication seems being progressively reduced with time after SVR. Data on recurrence of HCC after DAA exposure in patients with previously treated carcinoma initially reported conflicting results too, this being also due to methodological issues in analysis of retrospective multicenter studies. Anyway, current evidence support the use of DAAs in HCV-HCC treated patients, without any higher risk of tumor recurrence linked to antiviral therapy. Less effort has been made to evaluate the efficacy of DAA therapy in patients with untreated active HCC and it has been questioned whether a lower rate of SVR would be obtained among patients with active HCC. Studies conducted in this perspective concluded that HCC status does not influence the likelihood to obtain SVR with DAAs, making DAAs appropriate in HCC-active patients. As far as survival is concerned, recent studies conducted in cirrhotic HCV-related early-stage HCC found that DAAs improved overall survival, a benefit probably due to the reduction of hepatic decompensation.
直接作用抗病毒药物（DAAs）彻底改变了慢性 HCV 相关疾病的治疗方法，即使在晚期肝硬化中，也能达到高持续病毒学应答率（SVR），且禁忌症较少，不良反应发生率较低。然而，由于潜在的慢性肝脏疾病，即使在没有 HCC 病史的患者中，HCC 的风险仍然存在。尽管一些初步研究报告称 DAA 治疗后 HCC 发展的风险似乎较高，但最近的观察性研究否认了这一假设。在 SVR 后，随着时间的推移，HCV 清除后 HCC 发生的残余风险似乎逐渐降低。最初报告的关于 DAA 暴露后 HCC 复发的患者数据也存在相互矛盾的结果，这也是由于分析回顾性多中心研究的方法学问题所致。无论如何，目前的证据支持在 HCV-HCC 治疗患者中使用 DAA，与抗病毒治疗相关的肿瘤复发风险没有增加。对于未治疗的活动期 HCC 患者的 DAA 治疗效果的评估则相对较少，人们质疑在活动期 HCC 患者中是否会获得较低的 SVR 率。从这一角度进行的研究得出的结论是，HCC 状态不影响 DAA 获得 SVR 的可能性，使 DAA 适用于 HCC 活动期患者。就生存而言，最近在肝硬化 HCV 相关早期 HCC 中进行的研究发现，DAA 改善了总体生存率，这一获益可能归因于肝失代偿的减少。
