The risk of hepatocellular carcinoma in cirrhotic patients with hepatitis C and sustained viral response: Role of the treatment regimen
The risk of hepatocellular carcinoma in cirrhotic patients with hepatitis C and sustained viral response: Role of the treatment regimen
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DOI：
10.1016/j.jhep.2017.10.033
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发表时间：
2018-04-01
影响因子：
25.7
通讯作者：
Hutchinson, Sharon J.
中科院分区：
文献类型：
--
作者：
Innes, Hamish;Barclay, Stephen T.;Hutchinson, Sharon J.
背景与目的：先前的研究报道了晚期肝病患者在接受无干扰素（IFN）治疗丙型肝炎病毒（HCV）感染后发生肝细胞癌（HCC）的频率很高。我们的目的是利用苏格兰HCV临床数据库的数据来验证和解释这一现象。方法：我们确定了1997年至2016年在苏格兰接受抗病毒治疗的hcc初始肝硬化患者，导致持续的病毒学反应。患者从治疗开始日期开始随访至死亡日期、HCC发生日期或2017年1月31日。在校正相关辅助因素（包括：人口统计学因素、基线肝病分期、合并症/健康行为、病毒学和既往治疗经验）后，我们使用Cox回归比较不同治疗方案HCC发生的风险。通过HCV临床数据库和病历回顾确定HCC的发生。在我们的主要分析中，治疗方案被定义为不含ifn和含ifn。结果：共有857例患者符合研究标准，其中31.7%的患者接受了不含ifn的方案。接受无干扰素治疗的个体更可能是：年龄较大；在白人中，child - turcote - pugh B/C与child - turcote - pugh A；血小板减少的;non-genotype 3;治疗经验丰富。随访期间观察到46例HCC的发生。在单变量分析中，无ifn治疗与HCC风险显著增加相关（HR: 2.48; p = 0.021）。然而，在对基线因素进行多因素调整后，无ifn治疗的显著风险持续存在（aHR: 1.15, p = 0.744）。结论：这些研究结果表明，无ifn治疗持续病毒学应答后HCC的较高发生率与基线危险因素/患者选择有关，而与使用无ifn治疗本身无关。(C) 2017欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background & Aims: Previous studies have reported a high frequency of hepatocellular carcinoma (HCC) occurrence in patients with advanced liver disease, after receipt of interferon (IFN)-free therapy for hepatitis C virus (HCV) infection. Our objective was to verify and account for this phenomenon using data from the Scottish HCV clinical database.Methods: We identified HCC-naive individuals with liver cirrhosis receiving a course of antiviral therapy in Scotland from 1997-2016 resulting in a sustained virologic response. Patients were followed-up from their treatment start date to the earliest of: date of death, date of HCC occurrence, or 31 January 2017. We used Cox regression to compare the risk of HCC occurrence according to treatment regimen after adjusting for relevant cofactors (including: demographic factors; baseline liver disease stage; comorbidities/health behaviours, virology, and previous treatment experience). HCC occurrence was ascertained through both the HCV clinical database and medical chart review. For our main analysis, treatment regimen was defined as IFN-free vs. IFN-containing.Results: A total of 857 patients met the study criteria, of whom 31.7% received an IFN-free regimen. Individuals receiving IFN-free therapy were more likely to be: older; of white ethnicity, Child-Turcotte-Pugh B/C vs. Child-Turcotte-Pugh A; thrombocytopenic; non-genotype 3; and treatment experienced. HCC occurrence was observed in 46 individuals during follow-up. In univariate analysis, IFN-free therapy was associated with a significantly increased risk of HCC (HR: 2.48; p = 0.021). However, after multivariate adjustment for baseline factors, no significant risk attributable to IFN-free therapy persisted (aHR: 1.15, p = 0.744).Conclusion: These findings suggest that the higher incidence of HCC following sustained virologic response with IFN-free therapy relates to baseline risk factors/patient selection, and not the use of IFN-free therapy per se. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.