Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Ehime, Japan.
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
J Viral Hepat. 2022 Jul;29(7):551-558. doi: 10.1111/jvh.13684. Epub 2022 May 18.
Improvements in the hepatocellular carcinoma (HCC) recurrence rate and survival have been frequently reported following virus eradication after hepatitis C virus (HCV)-related HCC cure. However, the efficacy of direct-acting antiviral (DAA) therapy in patients who included those with advanced HCC and decreased hepatic functional reserve is unknown. A comparative examination was retrospectively conducted of 141 patients with hepatitis C who started DAA therapy within 1 year after undergoing curative HCC treatment and showed a sustained viral response (SVR) and 327 patients who underwent curative treatment for HCV-related HCC and did not subsequently receive antiviral therapy. Whether DAA therapy was given was identified as an independent factor related to both HCC recurrence and survival. Both the recurrence and survival rates improved significantly with DAA therapy in Child-Pugh (CP)-A, whereas no difference in the recurrence rate was seen with DAA therapy in CP-B. However, the survival rate was significantly higher in the DAA group in this class. Similarly, dividing the patients by the Milan criteria showed significant improvements in the recurrence rate and survival with DAA therapy in patients within the Milan criteria. Patients with HCC beyond the Milan criteria showed no difference in recurrence rates, but the DAA group tended to have higher survival rates. Thus, DAA after curative therapy for HCC can be expected to improve survival in patients with advanced HCC or decreased hepatic functional reserve. HCV should be aggressively eradicated in all patients eligible for curative treatment of HCC.
肝癌（HCC）患者在根治性 HCC 治疗后清除病毒后，肝癌复发率和生存率常得到改善。然而，直接作用抗病毒（DAA）治疗在包括晚期 HCC 和肝功能储备降低的患者中的疗效尚不清楚。回顾性比较了 141 例在根治性 HCC 治疗后 1 年内开始 DAA 治疗并获得持续病毒学应答（SVR）的丙型肝炎患者和 327 例未接受抗病毒治疗的丙型肝炎相关 HCC 根治性治疗患者。是否进行 DAA 治疗被确定为与 HCC 复发和生存相关的独立因素。在 CP-A 中，DAA 治疗显著改善了 HCC 复发和生存，而在 CP-B 中，DAA 治疗对 HCC 复发率没有差异。然而，在该类患者中，DAA 组的生存率显著更高。同样，根据米兰标准对患者进行分组，DAA 治疗在符合米兰标准的患者中显著改善了 HCC 复发率和生存率。超出米兰标准的 HCC 患者的复发率没有差异，但 DAA 组的生存率较高。因此，根治性 HCC 治疗后使用 DAA 有望改善晚期 HCC 或肝功能储备降低患者的生存率。所有适合 HCC 根治性治疗的患者都应积极清除 HCV。
