First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Japan.
Intern Med. 2022;61(18):2721-2729. doi: 10.2169/internalmedicine.8456-21. Epub 2022 Sep 15.
Objective Owing to advances in direct-acting antiviral (DAA) therapy, a considerable number of patients with hepatitis C virus (HCV)-positive hepatocellular carcinoma (HCC) are now able to achieve a sustained viral response (SVR) after curative treatment of HCC. However, the beneficial effect of a DAA-SVR on the survival remains unclear. Methods A total of 205 patients with HCC who were HCV-positive with Child-Pugh A at the onset from 2008 to 2018 were categorized into 2 groups: 140 patients untreated for HCV throughout the entire course after HCC development (untreated group) and 65 patients treated for HCV with DAAs following HCC treatment who achieved an SVR (SVR group). After propensity score matching, 63 patients from each group were selected. Using these patients, the survival and maintenance of Child-Pugh A after HCC treatment were compared between the untreated group and SVR group. Results There was a significant difference in the overall survival (p<0.001) and the rate of maintaining Child-Pugh A (p<0.001) between the groups. The 5-year survival rates were 96% (SVR group) and 60% (untreated group), and the proportions of patients with Child-Pugh A at 5 years after HCC treatment were 96% (SVR group) and 38% (untreated group). Conclusion In patients with HCV-positive HCC, achieving a DAA-SVR after HCC treatment significantly improved the overall survival rate compared with HCV-untreated patients. The contribution of DAA-SVR during the course of HCC treatment to a longer survival is mainly due to the prevention of the progression of Child-Pugh A to B/C. Further research is needed to determine whether aggressive antiviral therapy is also effective for HCC patients with Child-Pugh B/C.
由于直接作用抗病毒（DAA）治疗的进展，相当数量的丙型肝炎病毒（HCV）阳性肝细胞癌（HCC）患者现在能够在治愈 HCC 后实现持续病毒应答（SVR）。然而，DAA-SVR 对生存的有益影响尚不清楚。
2008 年至 2018 年间，共有 205 名 HCV 阳性、初发时为 Child-Pugh A 的 HCC 患者被分为两组：140 名患者在 HCC 发展后整个病程中未接受 HCV 治疗（未治疗组）和 65 名患者在 HCC 治疗后接受 DAA 治疗 HCV 并实现 SVR（SVR 组）。通过倾向评分匹配，每组选择 63 名患者。使用这些患者，比较未治疗组和 SVR 组 HCC 治疗后生存和维持 Child-Pugh A。
两组之间的总体生存率（p<0.001）和维持 Child-Pugh A 的比率（p<0.001）存在显著差异。5 年生存率分别为 96%（SVR 组）和 60%（未治疗组），5 年后 HCC 治疗后 Child-Pugh A 的患者比例分别为 96%（SVR 组）和 38%（未治疗组）。
在 HCV 阳性 HCC 患者中，与未治疗 HCV 的患者相比，在 HCC 治疗后实现 DAA-SVR 显著提高了总体生存率。在 HCC 治疗过程中，DAA-SVR 对更长生存的贡献主要归因于预防 Child-Pugh A 进展为 B/C。需要进一步研究以确定积极的抗病毒治疗是否对 Child-Pugh B/C 的 HCC 患者也有效。
