HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma
HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma
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DOI：
10.1016/j.jhep.2017.08.030
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发表时间：
2018-01-01
影响因子：
25.7
通讯作者：
Berry, Kristin
中科院分区：
文献类型：
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作者：
Ioannou, George N.;Green, Pamela K.;Berry, Kristin
背景和目标：目前尚不清楚直接作用的抗病毒药物（DAA）治疗诱导的持续病毒学应答（SVR）是否能降低HCV感染患者发生肝细胞癌（HCC）的风险。因此，在目前的研究中，我们的目的是确定DAA诱导的SVR对HCC风险的影响。我们确定了1999年1月1日至2015年12月31日期间在退伍军人事务部（VA）国家医疗保健系统中开始抗病毒治疗的62，354例患者，包括35，871例（58%）干扰素（IFN）单药治疗方案，4例，535例（7.2%）DAA + IFN方案，21，948例（35%）仅DAA方案。我们对患者进行了回顾性随访，直至2017年6月15日，以确定HCC的偶发病例。我们使用考克斯比例风险回归，以确定SVR和HCC风险之间的关联或类型之间的抗病毒治疗方案（DAA-只与DAA + IFN与IFN-只）和HCC risk.Results：我们确定了3,271例事件的HCC诊断至少180天后开始抗病毒治疗，在平均随访6.1年。肝硬化和治疗失败患者中HCC的发病率最高（3.25/100患者-年），其次是肝硬化和SVR（1.97），无肝硬化和治疗失败（0.87），无肝硬化和SVR（0.24）。在多变量模型中，SVR与HCC风险显著降低相关，无论抗病毒治疗是仅DAA（校正风险比[AHR] 0.29; 95% CI 0.23-0.37）、DAA + IFN（AHR 0.48; 95% CI 0.32-0.73）还是仅IFN（AHR 0.32; 95% CI 0.28-0.37）。DAA-单或DAA + IFN方案的接收与增加HCC风险没有相关性，与仅接受IFN方案相比。结论：DAA诱导的SVR与HCC风险降低71%相关。与IFN.Lay治疗相比，DAA治疗与HCC风险增加无关：目前尚不清楚直接作用的抗病毒治疗诱导的持续病毒学应答是否能降低HCV感染患者患肝癌的风险。我们证明，用直接作用的抗病毒药物根除HCV感染可使肝癌风险降低71%。由Elsevier B. V.代表欧洲肝脏研究协会出版。
Background & Aims: It is unclear whether direct-acting antiviral (DAA) treatment-induced sustained virologic response (SVR) reduces the risk of hepatocellular carcinoma (HCC) in patients with HCV infection. Therefore, in the current study, our aim was to determine the impact of DAA-induced SVR on HCC risk.Methods: We identified 62,354 patients who initiated antiviral treatment in the Veterans Affairs (VA) national healthcare system from 1 January 1999 to 31 December 2015, including 35,871 (58%) interferon (IFN)-only regimens, 4,535 (7.2%) DAA + IFN regimens, and 21,948 (35%) DAA-only regimens. We retrospectively followed patients until 15 June 2017 to identify incident cases of HCC. We used Cox proportional hazards regression to determine the association between SVR and HCC risk or between type of antiviral regimen (DAA-only vs. DAA + IFN vs. IFN-only) and HCC risk.Results: We identified 3,271 incident cases of HCC diagnosed at least 180 days after initiation of antiviral treatment during a mean follow-up of 6.1 years. The incidence of HCC was highest in patients with cirrhosis and treatment failure (3.25 per 100 patient-years), followed by cirrhosis and SVR (1.97), no cirrhosis and treatment failure (0.87), and no cirrhosis and SVR (0.24). SVR was associated with a significantly decreased risk of HCC in multivariable models irrespective of whether the antiviral treatment was DAA-only (adjusted hazard ratio [AHR] 0.29; 95% CI 0.23-0.37), DAA + IFN (AHR 0.48; 95% CI 0.32-0.73) or IFN-only (AHR 0.32; 95% CI 0.28-0.37). Receipt of a DAA-only or DAA + IFN regimen was not associated with increased HCC risk compared with receipt of an IFN-only regimen.Conclusions: DAA-induced SVR is associated with a 71% reduction in HCC risk. Treatment with DAAs is not associated with increased HCC risk compared with treatment with IFN.Lay summary: It was unclear whether direct-acting antiviral treatment-induced sustained virologic response reduces the risk of liver cancer in patients with HCV infection. We demonstrated that eradication of HCV infection with direct-acting antiviral agents reduces the risk of liver cancer by 71%. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.