Tahata Yuki, Sakamori Ryotaro, Maesaka Kazuki, Doi Akira, Yamada Ryoko, Kodama Takahiro, Hikita Hayato, Miyazaki Masanori, Nozaki Yasutoshi, Kaneko Akira, Oshita Masahide, Tanaka Satoshi, Imanaka Kazuho, Hiramatsu Naoki, Morishita Naoki, Ohkawa Kazuyoshi, Yakushijin Takayuki, Sakakibara Mitsuru, Iio Sadaharu, Doi Yoshinori, Tatsumi Tomohide, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Osaka Police Hospital, Osaka, Japan.
Hepatol Res. 2023 Apr;53(4):301-311. doi: 10.1111/hepr.13868. Epub 2022 Dec 22.
To determine the impact of direct-acting antiviral therapy on the long-term prognosis of decompensated cirrhotic patients.
A total of 37 patients with hepatitis C virus-induced decompensated cirrhosis treated with sofosbuvir and velpatasvir (SOF/VEL group) were prospectively enrolled. For historical control, 65 hepatitis C virus-positive decompensated cirrhotic patients who did not receive direct-acting antiviral therapy were included (control group). The incidence rates of hepatocellular carcinoma (HCC), decompensated events with hospitalization, and overall survival were compared between both groups.
A total of 41 patients experienced decompensated events during 15.0 months in the control group, and six patients during 21.6 months in the SOF/VEL group. The cumulative incidence rates of decompensated events after 2 years were significantly higher in the control group (53.1%) than in the SOF/VEL group (14.5%; p < 0.001). A total of 27 patients died within 22.0 months in the control group, and three patients died within 25.6 months in the SOF/VEL group. The overall survival rates after 2 years were significantly lower in the control group (67.6%) than in the SOF/VEL group (91.3%; p = 0.010). A total of 13 patients in the control group developed HCC during 15.8 months, and 10 patients during 17.3 months in the SOF/VEL group. The HCC incidence rates after 2 years were 20.3% and 29.6% in the control and SOF/VEL groups, respectively, with no significant difference (p = 0.327).
SOF/VEL therapy may suppress the development of decompensated events and improve the prognosis in decompensated cirrhotic patients; however, the incidence of HCC remains prevalent in these patients irrespective of SOF/VEL therapy.
确定直接抗病毒治疗对失代偿期肝硬化患者长期预后的影响。
前瞻性纳入37例接受索磷布韦和维帕他韦治疗的丙型肝炎病毒所致失代偿期肝硬化患者（索磷布韦/维帕他韦组）。作为历史对照，纳入65例未接受直接抗病毒治疗的丙型肝炎病毒阳性失代偿期肝硬化患者（对照组）。比较两组肝细胞癌（HCC）、失代偿事件伴住院以及总生存率的发生率。
对照组41例患者在15.0个月期间发生失代偿事件，索磷布韦/维帕他韦组6例患者在21.6个月期间发生失代偿事件。2年后失代偿事件的累积发生率在对照组（53.1%）显著高于索磷布韦/维帕他韦组（14.5%；p<0.001）。对照组27例患者在22.0个月内死亡，索磷布韦/维帕他韦组3例患者在25.6个月内死亡。2年后总生存率在对照组（67.6%）显著低于索磷布韦/维帕他韦组（91.3%；p=0.010）。对照组13例患者在15.8个月期间发生HCC，索磷布韦/维帕他韦组10例患者在17.3个月期间发生HCC。2年后HCC发生率在对照组和索磷布韦/维帕他韦组分别为20.3%和29.6%，无显著差异（p=0.327）。
索磷布韦/维帕他韦治疗可能抑制失代偿事件的发生并改善失代偿期肝硬化患者的预后；然而，无论是否接受索磷布韦/维帕他韦治疗，这些患者中HCC的发生率仍然较高。
