Postoperative direct-acting antiviral treatment after liver resection in patients with hepatitis C virus-related hepatocellular carcinoma
Postoperative direct-acting antiviral treatment after liver resection in patients with hepatitis C virus-related hepatocellular carcinoma
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丙型肝炎病毒相关性肝细胞癌患者肝切除术后直接抗病毒治疗
作者：
Tanaka S;Shinkawa H;Tamori A;Takemura S;Uchida-Kobayashi S;Amano R;Kimura K;Ohira G;Nishio K;Tauchi J;Kinoshita M;Kawada N;Kubo S.
目的我们研究丙型肝炎病毒（HCV）相关肝细胞癌（HCC）患者肝切除术后直接作用抗病毒药物（DAA）诱导的持续病毒学应答（SVR）对术后复发和生存的影响。方法将18例术后DAA诱导的SVR患者（HCC-DAA组）的手术结果与23例术前DAA诱导的SVR患者（DAA-HCC组）和20例术前DAA诱导的SVR患者（DAA-HCC组）的手术结果进行比较。 10名未接受DAA治疗的患者（对照组）。排除术后 1 年以上接受 DAA 治疗的患者和术后 1 年以内复发的患者。结果 HCC-DAA 组和 DAA-HCC 组术后 1 年血清转氨酶浓度均有所改善。白蛋白-胆红素 (ALBI) 1 级的 HCC-DAA 患者数量从 11 例增加到 15 例。HCC-DAA 组（3 年，60%）和其他两组（DAA-HCC 组，92% 和对照组，60%）之间的无病生存率没有差异。 DAA-HCC 组 (84%) 和 HCC-DAA 组 (100%) 的 3 年总体生存率优于对照组（46%；根据 Holm 检验，allps < 0.05）。多变量分析显示，肿瘤分期是术后复发的独立危险因素，术后1年的ALBI分级可以预测术后生存，但DAA诱导的SVR则不能预测术后生存。结论虽然术后DAA诱导的SVR本身可能不会抑制术后复发，但术后给予DAA导致的肝功能改善可能会延长术后生存。
AimWe investigated effects of direct‐acting antiviral (DAA)–induced sustained virological response (SVR) after liver resection in patients with hepatitis C virus (HCV)–related hepatocellular carcinoma (HCC) for postoperative recurrence and survival.MethodsSurgical outcomes in 18 patients with postoperative DAA‐induced SVR (HCC‐DAA group) were compared with those in 23 patients with preoperative DAA‐induced SVR (DAA‐HCC group) and those in 10 patients who did not receive DAA therapy (control group). Patients who received DAA therapy >1 year after surgery and those with recurrence <1 year after surgery were excluded.ResultsSerum concentrations of aminotransferases improved 1 year after surgery in both the HCC‐DAA and DAA‐HCC groups. The number of HCC‐DAA patients with albumin‐bilirubin (ALBI) grade 1 increased from 11 to 15. The disease‐free survival rate did not differ between HCC‐DAA group (3 years, 60%) and the other two groups (DAA‐HCC group, 92% and control group, 60%). The 3‐year overall survival rates were better in the DAA‐HCC group (84%) and HCC‐DAA group (100%) than in the control group (46%; allps < 0.05 according to Holm's test). Multivariable analysis revealed that tumor stage was an independent risk factor for postoperative recurrence, and ALBI grade at 1 year after surgery was predictive of postoperative survival, but DAA‐induced SVR was neither.ConclusionsAlthough postoperative DAA‐induced SVR itself may not suppress postoperative recurrence, improvement in liver function as a result of DAA administration after surgery may prolong postoperative survival.