Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Juntendo University, Tokyo, Japan.
Hepatol Commun. 2022 Sep;6(9):2496-2512. doi: 10.1002/hep4.2010. Epub 2022 May 31.
The prognostic impact of direct-acting antivirals (DAAs) on patients with hepatitis C-related hepatocellular carcinoma (C-HCC) is still unclear. This study aimed to evaluate the prognosis of C-HCC in the DAA era. We enrolled 1237 consecutive patients with treatment-naive C-HCC who underwent radical radiofrequency ablation between 1999 and 2019. We also enrolled 350 patients with nonviral HCC as controls. We divided these patients into three groups according to the year of initial treatment: 1999-2005 (cohort 1), 2006-2013 (cohort 2), and 2014-2019 (cohort 3). The use of antiviral agents and their effect in patients with C-HCC was investigated. Overall survival was evaluated for each cohort using the Kaplan-Meier method and a multivariable Cox proportional hazards regression model. Sustained virologic response (SVR) was achieved in 52 (10%), 157 (26%), and 102 (74%) patients with C-HCC in cohorts 1-3, respectively. The 3- and 5-year survival rates of patients with C-HCC were 82% and 59% in cohort 1; 80% and 64% in cohort 2; and 86% and 78% in cohort 3, respectively (p = 0.003). Multivariable analysis adjusted for age, liver function, and tumor extension showed that the prognosis of C-HCC improved in cohort 3 compared to cohort 1 (adjusted hazard ratio [aHR], 0.49; 95% confidence interval [CI], 0.32-0.73; p < 0.001), whereas the prognosis of nonviral HCC did not improve significantly (aHR, 0.96; 95% CI, 0.59-1.57; p = 0.88). The prognosis of C-HCC drastically improved with the advent of DAAs.
直接作用抗病毒药物 (DAA) 对丙型肝炎相关肝细胞癌 (C-HCC) 患者的预后影响尚不清楚。本研究旨在评估 DAA 时代 C-HCC 的预后。我们纳入了 1999 年至 2019 年期间接受根治性射频消融治疗的 1237 例初治 C-HCC 连续患者，并纳入了 350 例非病毒性 HCC 患者作为对照。我们根据初始治疗年份将这些患者分为三组：1999-2005 年（队列 1）、2006-2013 年（队列 2）和 2014-2019 年（队列 3）。研究了抗病毒药物的使用及其对 C-HCC 患者的影响。使用 Kaplan-Meier 方法和多变量 Cox 比例风险回归模型评估每个队列的总生存率。队列 1-3 中分别有 52 例（10%）、157 例（26%）和 102 例（74%）患者达到持续病毒学应答（SVR）。队列 1、2 和 3 中 C-HCC 患者的 3 年和 5 年生存率分别为 82%和 59%、80%和 64%以及 86%和 78%（p=0.003）。多变量分析调整了年龄、肝功能和肿瘤扩展，结果表明与队列 1 相比，队列 3 中 C-HCC 的预后有所改善（调整后的危险比[aHR]，0.49；95%置信区间[CI]，0.32-0.73；p<0.001），而非病毒性 HCC 的预后并未显著改善（aHR，0.96；95%CI，0.59-1.57；p=0.88）。随着 DAA 的出现，C-HCC 的预后急剧改善。
