Bucurica Sandica, Nancoff Andreea-Simona, Marin Raluca Ioana, Preda Carmen Monica
Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Gastroenterology, University Emergency Central Military Hospital "Dr. Carol Davila", 024185 Bucharest, Romania.
J Clin Med. 2025 Feb 24;14(5):1505. doi: 10.3390/jcm14051505.
: The issue of HCC recurrence in patients with liver cirrhosis and chronic HCV infection after DAA treatment as well as the issue of de novo HCC in individuals with chronic HCV hepatitis treated with DAA is of great importance. In this review, the two important aspects are discussed and, finally, an algorithm for approaching the patient with HCC and chronic HCV infection is proposed. : A literature search of the two databases (PubMed and Scopus) was conducted using the terms 'chronic hepatitis C' and/or 'liver cirrhosis' and 'hepatocellular carcinoma', from database inception to December 2024. : Thirty-one studies have examined the risk of HCC recurrence. Most of these studies conclude that DAA treatment reduces the risk of HCC recurrence compared to patients who did not receive DAA. There are considerable differences across various world regions. These variations may arise from: differences in genotypes, baseline characteristics of the populations, variability in DAA treatment protocols, and differences in follow-up intervals. Eleven studies that investigated the issue of de novo HCC after DAA were reviewed, of which two included historical cohorts of untreated patients. : The conclusion is that these patients present a low or equal risk of HCC incidence compared to untreated patients, and the risk factors for HCC are: lower platelet number, impaired liver function, nonresponse to DAA. Most patients with chronic hepatitis C and HCC should receive DAAs, except for those in BCLC stage D, but we must emphasize that timing of intervention is crucial and it is very important to evaluate possible drug interactions.
对于肝硬化和慢性丙型肝炎病毒（HCV）感染患者在接受直接抗病毒药物（DAA）治疗后肝癌复发的问题，以及接受DAA治疗的慢性HCV肝炎患者发生新发肝癌的问题，都非常重要。在本综述中，讨论了这两个重要方面，最后提出了一种针对肝癌合并慢性HCV感染患者的处理流程。：使用“慢性丙型肝炎”和/或“肝硬化”以及“肝细胞癌”等术语，对两个数据库（PubMed和Scopus）进行了从建库到2024年12月的文献检索。：有31项研究考察了肝癌复发风险。这些研究大多得出结论，与未接受DAA治疗的患者相比，DAA治疗降低了肝癌复发风险。不同世界区域存在相当大的差异。这些差异可能源于：基因型差异、人群基线特征、DAA治疗方案的变异性以及随访间隔的差异。对11项调查DAA治疗后新发肝癌问题的研究进行了综述，其中两项纳入了未治疗患者的历史队列。：结论是，与未治疗患者相比，这些患者发生肝癌的风险较低或相当，肝癌的危险因素为：血小板计数较低、肝功能受损、对DAA无反应。大多数慢性丙型肝炎合并肝癌患者应接受DAA治疗，BCLC D期患者除外，但我们必须强调，干预时机至关重要，评估可能的药物相互作用也非常重要。
