Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.
Cancer. 2022 Oct 1;128(19):3470-3478. doi: 10.1002/cncr.34378. Epub 2022 Jul 7.
Sustained viral response (SVR) improves survival for patients with hepatitis C (HCV) and hepatocellular carcinoma (HCC) after curative treatment; however, the benefit of SVR in those with active HCC with a significant competing risk of mortality is unknown. This study aimed to evaluate the association between SVR and outcomes in patients with active HCC.
The authors performed a multicenter, retrospective cohort study including consecutive adults with HCV cirrhosis and treatment-naive HCC diagnosed between 2014 and 2018. Patients were stratified into two groups: active viremia (n = 431) and SVR before HCC diagnosis (n = 135). All patients underwent nonsurgical therapy as their initial treatment and were followed until liver transplantation, last follow-up, or death. The primary outcome was incident or worsening hepatic decompensation within 6 months and the secondary outcome was overall survival. All analyses used inverse probability of treatment weights (IPTW) to account for differences between the nonrandomized cohorts.
Post-SVR patients had significantly lower odds of hepatic decompensation compared to viremic patients (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.06-0.59). Results were consistent among subgroups of patients with Child Pugh A cirrhosis (OR, 0.22; 95% CI, 0.04-0.77), Barcelona Clinic Liver Cancer stage B/C HCC (OR, 0.20; 95% CI, 0.04-0.65), and those receiving nonablative HCC therapies (OR, 0.21; 95% CI, 0.07-0.67). However, in IPTW multivariable Cox regression, SVR was not associated with improved survival (hazard ratio, 0.79; 95% CI, 0.56-1.12).
Patients with HCV-related HCC and SVR are less likely to experience hepatic decompensation than viremic patients, suggesting patients with HCC who are undergoing nonsurgical therapies may benefit from DAA treatment.
对于接受根治性治疗的丙型肝炎（HCV）和肝细胞癌（HCC）患者，持续病毒学应答（SVR）可改善生存；然而，对于伴有高死亡率的活跃 HCC 患者，SVR 的益处尚不清楚。本研究旨在评估 SVR 与活跃 HCC 患者结局的相关性。
作者进行了一项多中心、回顾性队列研究，纳入了 2014 年至 2018 年间诊断为 HCV 肝硬化和初治 HCC 的连续成年患者。患者分为两组：病毒血症（n=431）和 HCC 诊断前 SVR（n=135）。所有患者接受非手术治疗作为初始治疗，并随访至肝移植、最后随访或死亡。主要结局为 6 个月内发生或加重肝失代偿，次要结局为总生存。所有分析均使用治疗倾向评分（IPTW）来解释非随机队列之间的差异。
与病毒血症患者相比，SVR 患者发生肝失代偿的可能性显著降低（比值比 [OR]，0.18；95%置信区间 [CI]，0.06-0.59）。在亚组患者中，结果一致，包括 Child Pugh A 肝硬化（OR，0.22；95%CI，0.04-0.77）、巴塞罗那临床肝癌分期 B/C HCC（OR，0.20；95%CI，0.04-0.65）和接受非消融性 HCC 治疗的患者（OR，0.21；95%CI，0.07-0.67）。然而，在 IPTW 多变量 Cox 回归中，SVR 与生存改善无关（风险比，0.79；95%CI，0.56-1.12）。
与病毒血症患者相比，患有 HCV 相关 HCC 和 SVR 的患者发生肝失代偿的可能性较低，这表明接受非手术治疗的 HCC 患者可能从 DAA 治疗中获益。
