Impact of Obesity and Heavy Alcohol Consumption on Hepatocellular Carcinoma Development after HCV Eradication with Antivirals
Impact of Obesity and Heavy Alcohol Consumption on Hepatocellular Carcinoma Development after HCV Eradication with Antivirals
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DOI：
10.1159/000513705
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发表时间：
2021-06-04
期刊：
影响因子：
13.8
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Minami, Tatsuya;Tateishi, Ryosuke;Koike, Kazuhiko
背景和目的：目前尚不清楚肥胖是否会增加通过抗病毒治疗获得持续病毒学应答（SVR）的慢性丙型肝炎患者患肝细胞癌（HCC）的风险。方法：在这项多中心队列研究中，我们纳入了1990年1月1日至2018年12月31日期间通过基于干扰素（IFN）的治疗（IFN组）或直接作用抗病毒（DAA）治疗（DAA组）实现SVR的慢性丙型肝炎患者。这些患者接受了定期的HCC监测。分别使用 Kaplan-Meier 方法和 Cox 比例风险回归分析评估 SVR 后 HCC 的累积发生率和危险因素。结果：在 4.1 年的平均观察期内，2,055 名患者（IFN 组 840 名，DAA 组 1,215 名）中，75 名患者发展为 HCC（IFN 组 41 名，DAA 组 34 名）。 1年、2年、3年HCC发病率分别为1.2%、1.9%、3.0%。多变量分析显示，除了年龄较大之外，白蛋白水平较低、血小板计数较低、甲胎蛋白水平较高、无血脂异常、肥胖（体重指数>=25kg/m(2)）和大量饮酒（>=60g/天）是HCC发生的独立危险因素，调整后的风险比（HR）为2.53（95%置信区间[CI]）： 分别为 1.51-4.25）和 2.56（95% CI：1.14-5.75）。两组之间调整后的 HR 不显着（DAA 与 IFN；HR 1.19，95% CI：0.61-2.33）。结论：肥胖和大量饮酒会增加 SVR 后发生 HCC 的风险。
Background and Aims: It remains unclear whether obesity increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C who achieved a sustained virological response (SVR) with antiviral therapy. Methods: In this multicenter cohort study, we enrolled patients with chronic hepatitis C who achieved SVR with interferon (IFN)-based therapy (IFN group) or direct-acting antiviral (DAA) therapy (DAA group) between January 1, 1990, and December 31, 2018. The patients underwent regular surveillance for HCC. Cumulative incidence of and the risk factors for HCC development after SVR were assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis, respectively. Results: Among 2,055 patients (840 in the IFN group and 1,215 in the DAA group), 75 developed HCC (41 in the IFN group and 34 in the DAA group) during the mean observation period of 4.1 years. The incidence rates of HCC at 1, 2, and 3 years were 1.2, 1.9, and 3.0%, respectively. Multivariate analysis revealed that in addition to older age, lower albumin level, lower platelet count, higher alpha-fetoprotein level, and absence of dyslipidemia, obesity (body mass index >= 25 kg/m(2)) and heavy alcohol consumption (>= 60 g/day) were independent risk factors for HCC development, with adjusted hazard ratio (HR) of 2.53 (95% confidence interval [CI]: 1.51-4.25) and 2.56 (95% CI: 1.14-5.75), respectively. The adjusted HR was not significant between the 2 groups (DAA vs. IFN; HR 1.19, 95% CI: 0.61-2.33). Conclusions: Obesity and heavy alcohol consumption increased the risk of HCC development after SVR.