Lack of evidence of an effect of direct-acting antivirals on the recurrence of hepatocellular carcinoma: Data from three ANRS cohorts
Lack of evidence of an effect of direct-acting antivirals on the recurrence of hepatocellular carcinoma: Data from three ANRS cohorts
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没有证据表明直接作用抗病毒药物对肝细胞癌复发有影响：来自三个 ANRS 队列的数据
DOI：
10.1016/j.jhep.2016.05.045
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发表时间：
2016-10-01
影响因子：
25.7
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中科院分区：
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背景和目标：基于干扰素的抗病毒治疗慢性丙型肝炎后持续的病毒学应答与晚期肝纤维化患者肝细胞癌（HCC）的长期风险降低相关。一个意想不到的高肝癌复发率抗病毒治疗后，使用直接作用的抗病毒药物（DAA）最近已reported.Methods：我们分别从三个法国前瞻性多中心ANRS队列，包括6000多名患者接受DAA治疗的数据进行分析，我们专注于肝癌患者接受治疗程序DAA治疗前。其目的是评估这些患者的肝癌复发率根据抗病毒治疗regiment.Results：在ANRS CO22“治疗方案的肝炎B和C：法国队列”（HEPATHER）队列，267例慢性丙型肝炎谁是以前治疗的肝癌进行了分析，其中189人接受DAA和78没有。复发率分别为0.73/100和0.66/100人月。在ANRS CO 12“Cirrhose Virale”（CirVir）队列中，79例诊断和治疗HCC的患者中，13例接受DAA，66例未接受DAA。复发率分别为1.11/100和1.73/100人月。在ANRS CO23“蛋白酶抑制剂在病毒C肝移植中的综合使用”（CUPILT）队列中，分析了314例随后接受DAA治疗的HCC肝移植受者。在肝移植后中位时间70.3个月后报告了7例HCC复发。复发率为2.2%。结论：在三个不同的前瞻性队列中，我们没有观察到DAA治疗后HCC复发的风险增加，特别是在接受根治性HCC治疗（包括肝移植）的患者中。由于一项回顾性研究表明，直接作用抗病毒（DAA）治疗后肝细胞癌（HCC）复发率意外高，我们分析了来自三个法国前瞻性多中心ANRS队列的数据，这些队列包括>6000名接受根治性HCC治疗的DAA治疗患者。我们没有观察到DAA治疗后HCC复发的风险增加：治疗和未治疗患者的复发率相似（ANRS CO22肝细胞疗法队列中为0.73/100和0.66/100人月，包括189例DAA+和78例DAA，DAA+为1.11/100，1.73/100人月）在ANRS CO 12 CirVir队列中，66 DAA中的月）。最后，在ANRS CO23 CUPILT队列中，在314例（2.2%）肝移植后70个月接受治疗的肝移植受者中，仅7例（2.2%）肝细胞癌复发。(C)2016由Elsevier B. V.代表欧洲肝脏研究协会发表。
Background & Aims: Sustained virological response following interferon-based antiviral treatment of chronic hepatitis C is associated with decreased long-term risk of hepatocellular carcinoma (HCC) in advanced liver fibrosis. An unexpected high rate of HCC recurrence following antiviral treatment using direct-acting antiviral (DAA) has recently been reported.Methods: We analyzed data individually from three French prospective multicentre ANRS cohorts including more than 6000 patients treated with DAA and we focused on HCC patients who underwent curative procedures before DAA treatment. The aim was to assess the rates of HCC recurrence in these patients according to antiviral treatment regimen.Results: In the ANRS CO22 "Therapeutic options for hepatitis B and C: a French cohort" (HEPATHER) cohort, 267 patients with chronic hepatitis C who were previously treated for HCC were analyzed, among whom 189 received DAA and 78 did not. The rates of recurrence were 0.73/100 and 0.66/100 person-months, respectively. In the ANRS CO12 "Cirrhose Virale" (CirVir) cohort, 79 cirrhotic patients in whom HCC was diagnosed and treated, 13 received DAA and 66 did not. The rates of recurrence were 1.11/100 and 1.73/100 person-months, respectively. In the ANRS CO23 "Compassionate use of Protease Inhibitors in viral C Liver Transplantation" (CUPILT) Cohort, 314 liver transplant recipients for HCC who were subsequently treated with DAA were analyzed. Seven HCC recurrences were reported after a median time of 70.3 months after liver transplantation. The rate of recurrence was 2.2%.Conclusions: In three distinct prospective cohorts, we did not observe an increased risk of HCC recurrence after DAA treatment, notably in patients who underwent curative HCC treatment including liver transplantation.Lay summary: Since an unexpected high rate of hepatocellular carcinoma (HCC) recurrence after direct-acting antiviral (DAA) treatment has been suggested in a retrospective study, we analyzed data from three French prospective multicentre ANRS cohorts of >6000 DAA-treated patients who underwent curative HCC therapies. We did not observe an increased risk of HCC recurrence after DAA treatment: the rates of recurrence were similar in treated and untreated patients (0.73/100 and 0.66/100 person-months in in the ANRS CO22 HEPATHER cohort including 189 DAA+ and 78 DAA and 1.11/100 in DAA+ and 1.73/100 person-months in 66 DAA in the ANRS CO12 CirVir cohort), respectively. Finally, in the ANRS CO23 CUPILT Cohort, HCC recurred in only 7 among 314 (2.2%) liver transplant recipients for HCC subsequently treated after 70 months after liver transplantation. (C) 2016 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.