Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.
Aliment Pharmacol Ther. 2024 Oct;60(7):940-952. doi: 10.1111/apt.18199. Epub 2024 Aug 7.
The benefits of HCV eradication on distinct recurrence patterns and long-term hepatic outcomes in patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA) remain uncertain. This study aims to assess the impact of HCV eradication on HCC recurrence patterns and long-term hepatic outcomes after RFA and to identify predictors of recurrence in patients achieving sustained virological response (SVR).
We retrospectively enrolled 274 patients receiving RFA for HCV-related HCC, including 73 and 88 patients treated with interferon-based (IFN) and direct-acting antivirals (DAA) therapy, respectively. We analysed factors associated with local tumour progression (LTP), distant recurrence, overall survival, and hepatic decompensation.
SVR was achieved in 49.3% of patients undergoing IFN therapy and 93.2% of patients undergoing DAA therapy. HCV eradication was not associated with LTP but significantly correlated with reduced risk of distant recurrence (by DAA: hazard ratio (HR) = 0.449, p = 0.006), overall survival (by IFN: HR = 0.242, p < 0.001; by DAA: HR = 0.274, p < 0.001) and hepatic decompensation (by IFN: HR = 0.313, p = 0.004; by DAA: HR = 0.281, p < 0.001). The benefits of achieving SVR in terms of overall survival and hepatic decompensation remained significant in subgroups of patients with and without recurrence. Patients with SVR showed a significant decline in FIB-4 score and a higher proportion of ALBI grade improvement. Among SVR patients, the IMbrave050 criteria predicted LTP but not distant recurrence, whereas the FIB-4 score after SVR, rather than the baseline FIB-4, predicted distant recurrence.
HCV eradication was associated with a significant reduction in distant recurrence, mortality and hepatic decompensation following RFA in patients with HCV-related HCC.
在接受射频消融（RFA）治疗的肝细胞癌（HCC）患者中，HCV 清除对不同复发模式和长期肝脏结局的益处尚不确定。本研究旨在评估 HCV 清除对 RFA 后 HCC 复发模式和长期肝脏结局的影响，并确定获得持续病毒学应答（SVR）患者复发的预测因素。
我们回顾性纳入了 274 例接受 RFA 治疗的 HCV 相关 HCC 患者，其中分别有 73 例和 88 例患者接受了干扰素（IFN）和直接作用抗病毒药物（DAA）治疗。我们分析了与局部肿瘤进展（LTP）、远处复发、总生存和肝失代偿相关的因素。
IFN 治疗组患者的 SVR 率为 49.3%，DAA 治疗组患者的 SVR 率为 93.2%。HCV 清除与 LTP 无关，但与远处复发风险降低显著相关（通过 DAA：风险比（HR）=0.449，p=0.006）、总生存（通过 IFN：HR=0.242，p<0.001；通过 DAA：HR=0.274，p<0.001）和肝失代偿（通过 IFN：HR=0.313，p=0.004；通过 DAA：HR=0.281，p<0.001）。在有和无复发的患者亚组中，达到 SVR 对总生存和肝失代偿的获益仍然显著。SVR 患者的 FIB-4 评分显著下降，ALBI 分级改善的比例更高。在 SVR 患者中，IMbrave050 标准预测 LTP，但不预测远处复发，而 SVR 后的 FIB-4 评分，而不是基线 FIB-4 评分，预测远处复发。
在接受 HCV 相关 HCC 患者的 RFA 治疗后，HCV 清除与远处复发、死亡率和肝失代偿的显著减少相关。
