直接抗病毒药物根除病毒对丙型肝炎病毒相关肝细胞癌根治后临床结果的影响

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2025-03-12 eCollection Date: 2025-01-01 DOI:10.1177/17562848251324094

Yuko Nagaoki, Kenji Yamaoka, Yasutoshi Fujii, Shinsuke Uchikawa, Hatsue Fujino, Atsushi Ono, Eisuke Murakami, Tomokazu Kawaoka, Daiki Miki, Hiroshi Aikata, Clair Nelson Hayes, Masataka Tsuge, Shiro Oka

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引用次数: 0

摘要

背景：目前尚不清楚丙型肝炎病毒（HCV）的抗病毒治疗对肝细胞癌（HCC）治愈后恢复是否有抑制复发或提高生存率的作用。目的：我们分析了不含干扰素（IFN）的直接抗病毒（DAA）根除治疗对接受根治性治疗的丙型肝炎相关HCC患者临床结局的影响。设计：这是一项回顾性研究。方法：我们回顾性分析了109例HCC治疗后持续接受DAA治疗的患者，并分析了HCC复发和总生存期（OS）。在这些患者中，有HCC复发史，并且在开始DAA治疗之前，将HCC治疗作为确定的HCC治疗。结果：109例HCC患者中，64例在根治后接受DAA治疗；其余45人接受了小于2的后续HCC治疗。1年、3年和5年的累积HCC复发率分别为23%、47%和56%。多因素分析发现抑制HCC复发的预测因素为肿瘤数量(多例的危险比（HR） 2.293；p = 0.006)和DAA治疗前HCC治疗次数(HR为2.928；p = 0.001)。在64例接受根治性治疗的HCC患者中，1年、3年和5年HCC累计首次复发率分别为12%、34%和44%，第二次复发率分别为11%、28%和39%，第三次复发率分别为0%、22%和53%；复发倾向于抑制到3年。3年和5年的累计OS率分别为87%和75%。多因素分析：单个患者肿瘤数（HR 2.452）；p = 0.026)是OS的唯一独立预测因子。结论：肝细胞癌根治性治疗后DAA治疗可长期抑制肝细胞癌复发，但有多次肝细胞癌治疗史的患者复发率较高。

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Impact of viral eradication by direct-acting antivirals on clinical outcomes after curative treatment for hepatitis C virus-associated hepatocellular carcinoma.

Background: It is not clear that antiviral therapy for hepatitis C virus (HCV) after recovery from curative treatment for hepatocellular carcinoma (HCC) has an effect on suppressing recurrence or improving survival rates.

Objectives: We analyzed the impact of eradication by interferon (IFN)-free direct-acting antiviral (DAA) therapy on clinical outcomes of patients with HCV-associated HCC who underwent curative treatment.

Design: This was a retrospective study.

Methods: We retrospectively reviewed 109 consecutive patients with sustained virologic response with DAA therapy after HCC treatment and analyzed HCC recurrence and overall survival (OS). Among these patients are those with a history of HCC recurrence and curative HCC treatments administered as definitive HCC treatments prior to initiation of DAA therapy.

Results: Among 109 patients, 64 received DAA therapy after curative treatment for HCC; the remaining 45 received ⩾2 subsequent treatments for HCC. Cumulative HCC recurrence rates at 1, 3, and 5 years were 23%, 47%, and 56%, respectively. Multivariate analysis identified predictive factors for suppression of HCC recurrence as tumor number (hazard ratio (HR) 2.293 for multiple; p = 0.006) and number of HCC treatments before DAA therapy (HR 2.928 for ⩾2; p = 0.001). Among 64 patients who received curative treatment for HCC, cumulative first HCC recurrence rates at 1, 3, and 5 years were 12%, 34%, and 44%, respectively, second recurrence rates were 11%, 28%, and 39%, and third recurrence rates were 0%, 22%, and 53%, respectively; recurrence tended to be suppressed until 3 years. Cumulative OS rates at 3 and 5 years were 87% and 75%, respectively. On multivariate analysis, tumor number (HR 2.452 for single; p = 0.026) was the only independent predictor of OS.

Conclusion: DAA therapy after curative treatment for HCC suppresses HCC recurrence in the long term, but recurrence was higher in patients with a history of many HCC treatments.

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.