直接作用抗病毒药物降低肝切除术后丙型肝炎病毒相关肝细胞癌的死亡率和复发率：一项多中心国际研究。
Direct-acting antivirals lower mortality and recurrence in HCV-related hepatocellular carcinoma post liver resection: A multicenter international study.
作者信息
Choi Woo Jin, Ivanics Tommy, Claasen Marco, Magyar Christian T J, Li Zhihao, Tabrizian Parissa, Rocha Chiara, Myers Bryan, O'Kane Grainne M, Reig Maria, Ferrer Fàbrega Joana, Holgin Victor, Parikh Neehar D, Pillai Anjana, Hunold Thomas M, Vogel Arndt, Patel Madhukar S, Singal Amit G, Tadros Meena, Feld Jordan J, Hansen Bettina, Sapisochin Gonzalo
机构信息
Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University Health Network, HPB Oncology Research, Toronto, ON, Canada.
University Health Network, HPB Oncology Research, Toronto, ON, Canada; Department of Surgery, Henry Ford Hospital, Detroit, MI; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
出版信息
Surgery. 2025 Jul;183:109396. doi: 10.1016/j.surg.2025.109396. Epub 2025 May 6.
BACKGROUND
The impact of treatment on hepatitis C virus with direct-acting antivirals on 90-day postoperative outcomes, overall survival, and recurrence-free survival in patients after liver resection for hepatocellular carcinoma is unknown.
METHODS
We conducted a multicenter retrospective study. Adults who underwent liver resection for hepatitis C virus-related hepatocellular carcinoma between January 2000 and December 2018 were included from 7 international institutions. Groups included direct-acting antiviral treated, non-direct-acting antiviral treated, and untreated hepatitis C virus infection. We used a multivariable model to evaluate the association between receipt of preoperative direct-acting antivirals and 90-day postoperative major complications (Clavien-Dindo class ≥III).
RESULTS
We identified 738 patients, including 206 (28%) direct-acting antiviral treated, 241 (33%) non-direct-acting antiviral treated, and 291 (39%) untreated patients. The sustained virologic response rate was 92% in the direct-acting antiviral and 71% in the non-direct-acting antiviral treatment groups. The median follow-up was 7.6 years (95% confidence interval 6.1, 8.6) after surgery for the entire cohort. Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those without antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.26 [0.19, 0.35] and 0.52 [0.43, 0.64], respectively). Patients who received direct-acting antiviral therapy had better 5-year overall and recurrence-free survival than those who received non-direct-acting antiviral therapy (adjusted hazard ratio [95% confidence interval]: 0.49 [0.36, 0.66] and 0.78 [0.63, 0.96], respectively). There was no significant association between preoperative direct-acting antiviral therapy and 90-day postoperative major complications (adjusted odds ratio 0.34, 95% confidence interval 0.08, 1.01).
CONCLUSION
Direct-acting antiviral therapy is associated with improved 5-year overall and recurrence-free survival, without significantly increased risk of 90-day postoperative complications, in patients undergoing liver resection for hepatitis C virus-related hepatocellular carcinoma.
背景
直接作用抗病毒药物治疗丙型肝炎病毒对肝细胞癌肝切除术后患者90天术后结局、总生存期和无复发生存期的影响尚不清楚。
方法
我们开展了一项多中心回顾性研究。纳入了2000年1月至2018年12月期间在7家国际机构接受丙型肝炎病毒相关肝细胞癌肝切除术的成年人。分组包括接受直接作用抗病毒治疗、未接受直接作用抗病毒治疗和未治疗的丙型肝炎病毒感染。我们使用多变量模型评估术前接受直接作用抗病毒药物与90天术后严重并发症（Clavien-Dindo分级≥III级）之间的关联。
结果
我们纳入了738例患者，其中206例（28%）接受直接作用抗病毒治疗，241例（33%）接受非直接作用抗病毒治疗，291例（39%）未接受治疗。直接作用抗病毒治疗组的病毒学持续应答率为92%，非直接作用抗病毒治疗组为71%。整个队列术后的中位随访时间为7.6年（95%置信区间6.1, 8.6）。接受直接作用抗病毒治疗的患者5年总生存期和无复发生存期均优于未接受抗病毒治疗的患者（校正风险比[95%置信区间]：分别为0.26[0.19, 0.35]和0.52[0.43, 0.64]）。接受直接作用抗病毒治疗的患者5年总生存期和无复发生存期均优于接受非直接作用抗病毒治疗的患者（校正风险比[95%置信区间]：分别为0.49[0.36, 0.66]和0.78[0.63, 0.96]）。术前直接作用抗病毒治疗与90天术后严重并发症之间无显著关联（校正比值比0.34，95%置信区间0.08, 1.01）。
结论
对于接受丙型肝炎病毒相关肝细胞癌肝切除术的患者，直接作用抗病毒治疗与5年总生存期和无复发生存期改善相关，且90天术后并发症风险无显著增加。
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