Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Viruses. 2024 Sep 18;16(9):1485. doi: 10.3390/v16091485.
Hepatocellular carcinoma (HCC) remains a significant concern for patients with chronic hepatitis C (HCV), even after achieving a sustained virological response (SVR) with direct-acting antivirals (DAAs) or interferon (IFN)-based therapies. This study compared the risk of HCC in patients with HCV who achieved SVR through the DAA versus IFN regimens.
A retrospective analysis was conducted on 4806 HCV patients, without coinfection nor prior HCC history, treated at the Chang Gung Memorial Hospital, Taiwan (DAA: 2825, IFN: 1981). Kaplan-Meier and Cox regression analyses with propensity score matching (PSM) were used to adjust for baseline differences.
DAA-treated patients exhibited a higher incidence of HCC than IFN-treated patients before and after PSM (after PSM: annual: 1% vs. 0.5%; 6-year: 6% vs. 3%, = 0.01). Both DAA and IFN patients had a decreased HCC incidence during follow-up (>3 vs. <3 years from the end of treatment: DAA: 1.43% vs. 1.00% per year; IFN: 0.47% vs. 0.36% per year, both < 0.05). HCC incidence was higher in the first three years post-SVR in DAA-treated ACLD patients and then decreased (3.26% vs. 1.39% per year, < 0.01). In contrast, HCC incidence remained constant in the non-ACLD and IFN-treated groups. Multivariate Cox regression identified age ≥ 60, male sex, BMI, AFP ≥ 6 ng/mL, FIB-4, and ACLD status as independent risk factors for HCC, but antiviral regimens were not an independent factor for HCC.
DAA treatment significantly affects HCC risk primarily within three years post-treatment, especially in younger HCV patients with ACLD. HCC incidence was reduced after three years in ACLD patients treated by DAA, but continued surveillance was still necessary. However, patients under 60 without advanced liver disease may require less intensive follow-up.
即使慢性丙型肝炎 (HCV) 患者通过直接作用抗病毒药物 (DAA) 或基于干扰素 (IFN) 的治疗方案实现持续病毒学应答 (SVR)，肝细胞癌 (HCC) 仍然是他们的一个重大隐患。本研究比较了 HCV 患者通过 DAA 与 IFN 方案实现 SVR 后 HCC 的发病风险。
对台湾长庚纪念医院的 4806 例无合并感染且无 HCC 病史的 HCV 患者进行回顾性分析（DAA：2825 例，IFN：1981 例）。采用 Kaplan-Meier 分析和 Cox 回归分析，并进行倾向评分匹配 (PSM) 以调整基线差异。
在 PSM 前后，DAA 治疗组患者 HCC 的发病率均高于 IFN 治疗组（PSM 后：年发生率：1%比 0.5%；6 年发生率：6%比 3%， = 0.01）。在随访期间，DAA 和 IFN 患者的 HCC 发病率均降低（治疗结束后 >3 年与 <3 年：DAA：每年 1.43%比 1.00%；IFN：每年 0.47%比 0.36%，两者均 < 0.05）。DAA 治疗的 ACLD 患者在 SVR 后前三年 HCC 发病率较高，然后降低（3.26%比每年 1.39%， < 0.01）。相比之下，非 ACLD 和 IFN 治疗组的 HCC 发病率保持不变。多变量 Cox 回归分析确定年龄≥60 岁、男性、BMI、AFP≥6ng/ml、FIB-4 和 ACLD 状态为 HCC 的独立危险因素，但抗病毒方案不是 HCC 的独立危险因素。
DAA 治疗主要在治疗后三年内显著影响 HCC 风险，尤其是在年轻的伴有 ACLD 的 HCV 患者中。DAA 治疗的 ACLD 患者在三年内 HCC 发病率降低，但仍需持续监测。然而，年龄<60 岁且无晚期肝病的患者可能需要较少的强化随访。
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