Department of Internal Medicine, Division of Gastroenterology & Hepatology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
Departments of Surgery and Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
J Gastrointest Cancer. 2024 Sep;55(3):1324-1332. doi: 10.1007/s12029-024-01076-w. Epub 2024 Jul 8.
This study tested the hypothesis that our predominately AA medical center population would demonstrate a decline in HCV-driven HCC diagnosis following the initiation of DAA treatment in 2014. Also evaluated was whether achieving an SVR prior to diagnosis of HCC improved outcomes in patients who had an HCV diagnosis after completion of treatment.
All patients with HCC seen at the Detroit Medical Center from 2009 to 2021 were identified using ICD-10 codes, and medical records were evaluated. Outcomes were evaluated as either alive or death/hospice as of December of 2022.
There were 461 patients with HCC of whom 433 (94%) had racial information in the database (AA = 351; non-AA = 82). HCC incidence regardless of race peaked in 2017, with a subsequent decline through 2021. HCV as a risk factor was higher in AA as compared to non-AA (85% vs. 53% p = 0.0001). Outcome (alive vs. death/hospice) was better for SVR patients compared to untreated patients (54% vs. 19%; p = 0.0009). HCC patients who achieved SVR also had better liver function at diagnosis as defined by Child-Pugh score (74% vs. 49% Class A p = 0.04) at the time of diagnosis.
Racial disparity in HCC etiology was confirmed with AA more likely to have HCV than non-AA. The reduction in HCC patients with HCV confirms the impact of DAA treatment and prior successful treatment of HCV yields better outcomes. Increasing HCV treatment rates especially in AA patients will have a major impact on HCC development and treatment outcomes.
• African Americans are more likely to have HCV infection as compared to non-AA. • Hepatocellular carcinoma is increasing in incidence in the US. • The role of HCV in the development of HCC remains to be further investigated.
• HCC diagnosis in a single urban medical center study increased from 2009 as a result of HCV as a risk factor. • HCC declined post 2018 due primarily to a reduction in HCV infection as the risk factor. • African Americans were more likely to have HCV as the risk factor as compared to non-AA patients who were more likely to have no known risk factor on record (i.e., cryptogenic).
本研究旨在检验以下假设，即我们主要由非裔美国人组成的医疗中心人群在 2014 年开始接受直接作用抗病毒药物 (DAA) 治疗后，丙型肝炎病毒 (HCV) 导致的肝癌诊断病例数将减少。本研究还评估了在 HCC 诊断前实现持续病毒学应答 (SVR) 是否能改善治疗完成后诊断出 HCV 的患者的结局。
使用国际疾病分类第 10 次修订版 (ICD-10) 代码从 2009 年至 2021 年在底特律医疗中心就诊的所有 HCC 患者均被识别出来，并对其病历进行了评估。截至 2022 年 12 月，根据患者生存或死亡/临终关怀情况评估结局。
共纳入 461 例 HCC 患者，其中 433 例（94%）数据库中记录了种族信息（非裔美国人=351 例；非非裔美国人=82 例）。无论种族如何，HCC 发病率在 2017 年达到峰值，随后在 2021 年下降。非裔美国人的 HCV 作为风险因素的比例高于非非裔美国人（85%比 53%，p=0.0001）。与未治疗患者相比，SVR 患者的结局（生存或死亡/临终关怀）更好（54%比 19%，p=0.0009）。与未治疗患者相比，获得 SVR 的 HCC 患者在诊断时的肝功能（根据 Child-Pugh 评分定义）也更好，其中 74%的患者为 A 级，而 49%的患者为 C 级（p=0.04）。
本研究证实了 HCC 病因在非裔美国人中存在种族差异，非裔美国人更有可能因 HCV 而患病。HCV 相关 HCC 患者数量的减少证实了 DAA 治疗的影响，而成功治疗 HCV 也能带来更好的结局。尤其是在非裔美国人中增加 HCV 治疗率，将对 HCC 的发展和治疗结局产生重大影响。
• 与非非裔美国人相比，非裔美国人更有可能感染丙型肝炎病毒。• 在美国，肝细胞癌的发病率呈上升趋势。• HCV 在 HCC 发展中的作用仍需进一步研究。
• 在单家城市医疗中心的研究中，由于 HCV 是风险因素，HCC 的诊断从 2009 年开始增加。• 2018 年后，HCC 减少主要是由于 HCV 感染作为风险因素的减少。• 与非非裔美国人相比，非裔美国人更有可能因 HCV 作为风险因素而患病，而非非裔美国人更有可能在记录中没有已知的风险因素（即不明原因）。
