Ogawa Eiichi, Kawano Akira, Kohjima Motoyuki, Koyanagi Toshimasa, Dohmen Kazufumi, Ooho Aritsune, Satoh Takeaki, Takahashi Kazuhiro, Furusyo Norihiro, Kajiwara Eiji, Azuma Koichi, Ichiki Yasunori, Sugimoto Rie, Amagase Hiromasa, Senju Takeshi, Tanaka Masatake, Nakamuta Makoto, Nomura Hideyuki, Hayashi Jun
Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
J Gastroenterol Hepatol. 2025 Apr;40(4):971-978. doi: 10.1111/jgh.16892. Epub 2025 Feb 2.
More accurate stratification of patients with chronic hepatitis C after permanent hepatitis C virus (HCV) clearance by direct-acting antivirals (DAAs) is important for improving long-term surveillance and treatment. The aim of this study was to stratify patients with chronic hepatitis C who are at risk of developing hepatocellular carcinoma (HCC) after HCV cure.
This multicenter, retrospective cohort study included 3177 consecutive adult chronic hepatitis C patients without decompensated cirrhosis who were treated with all-oral DAAs. The primary study endpoints were long-term cumulative de novo HCC incidence, HCC recurrence rates, and survival. Additionally, we analyzed the development of HCC by patients without cirrhosis, stratified by age and fibrosis status according to the FIB-4 index.
After exclusions, data from 3024 patients were available for analysis. The overall median follow-up period was 6.5 years. None of the patients with non-cirrhosis/FIB-4 < 1.45 (n = 475) developed HCC regardless of background factors. For patients with non-cirrhosis/FIB-4 ≥ 3.25, older age had a greater impact on HCC incidence (log-rank test: p = 0.038). In addition, metabolic factors, including body mass index and diabetes mellitus, were not related to HCC incidence. HCC recurrence commonly occurred within 5 years after HCV cure; nevertheless, HCV cure contributed to an improvement of survival rates.
Age is a pivotal factor in predicting de novo HCC development following HCV cure in patients with moderate to advanced fibrosis. Conversely, patients with mild fibrosis (FIB-4 < 1.45) may be eligible for discharge from specialized care after achieving HCV elimination.
对于接受直接抗病毒药物（DAA）治疗后实现丙型肝炎病毒（HCV）持续清除的慢性丙型肝炎患者，更准确的分层对于改善长期监测和治疗至关重要。本研究旨在对HCV治愈后有发生肝细胞癌（HCC）风险的慢性丙型肝炎患者进行分层。
这项多中心回顾性队列研究纳入了3177例连续的成年慢性丙型肝炎患者，这些患者均未出现失代偿性肝硬化，且接受了全口服DAA治疗。主要研究终点为长期累积新发HCC发病率、HCC复发率和生存率。此外，我们分析了无肝硬化患者中HCC的发生情况，并根据FIB-4指数按年龄和纤维化状态进行分层。
排除部分患者后，3024例患者的数据可供分析。总体中位随访期为6.5年。无论背景因素如何，非肝硬化/FIB-4<1.45的患者（n = 475）均未发生HCC。对于非肝硬化/FIB-4≥3.25的患者，年龄对HCC发病率的影响更大（对数秩检验：p = 0.038）。此外，包括体重指数和糖尿病在内的代谢因素与HCC发病率无关。HCC复发通常发生在HCV治愈后的5年内；然而，HCV治愈有助于提高生存率。
年龄是预测中重度纤维化患者HCV治愈后新发HCC发生的关键因素。相反，轻度纤维化（FIB-4<1.45）的患者在实现HCV清除后可能有资格从专科护理中出院。
