Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients
Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients
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DOI：
10.1016/j.jhep.2019.03.027
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发表时间：
2019-08-01
影响因子：
25.7
通讯作者：
Camma, Calogero
中科院分区：
文献类型：
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作者：
Cabibbo, Giuseppe;Celsa, Ciro;Camma, Calogero
背景和目标：在成功治疗早期肝细胞癌（HCC）后，直接作用抗病毒药物（DAA）对丙型肝炎病毒（HCV）的有效性已被广泛研究。然而，总生存期（OS）方面的获益仍有待最终证实。本研究的目的是评估的影响DAAs OS，肝癌复发，肝失代偿。方法：我们前瞻性地纳入了163例连续与HCV相关的肝硬化和第一次诊断的早期巴塞罗那诊所肝癌阶段0/A肝癌，谁取得了完全的放射学反应后，根治性切除或消融，随后与DAAs治疗。来自ITA.LI.CA .同期对照组（n = 328）。倾向评分匹配后，102 DAA治疗（DAA组）和102 DAA未治疗的患者（无DAA组）的结局进行了比较。结果：在DAA组，7/102例（6.9%）死亡，28/102例（27.5%）HCC复发，6/102例（5.9%）发生肝失代偿，平均随访21.4个月。DAA组的OS显著高于无DAA组（风险比[HR] 0.39; 95% CI 0.17-0.91; p = 0.03）。DAA组和无DAA组之间HCC复发无显著差异（HR 0.70; 95% CI 0.44-1.13; p = 0.15）。与无DAA组相比，在DAA组中观察到肝失代偿率显著降低（HR 0.32; 95% CI 0.13-0.84; p = 0.02）。在DAA组中，持续的病毒学应答是OS的显著预测因子（HR 0.02; 95%CI 0.00-0.19; p
Background & Aims: The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV), following successful treatment of early hepatocellular carcinoma (HCC), has been studied extensively. However, the benefit in terms of overall survival (OS) remains to be conclusively demonstrated. The aim of this study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic decompensation.Methods: We prospectively enrolled 163 consecutive patients with HCV-related cirrhosis and a first diagnosis of early Barcelona Clinic Liver Cancer stage 0/A HCC, who had achieved a complete radiologic response after curative resection or ablation and were subsequently treated with DAAs. DAAuntreated patients from the ITA.LI.CA . cohort (n = 328) served as controls. After propensity score matching, outcomes of 102 DAA-treated (DAA group) and 102 DAA-untreated patients (No DAA group) were compared.Results: In the DAA group, 7/102 patients (6.9%) died, HCC recurred in 28/102 patients (27.5%) and hepatic decompensation occurred in 6/102 patients (5.9%), after a mean follow-up of 21.4 months. OS was significantly higher in the DAA group compared to the No DAA group (hazard ratio [HR] 0.39; 95% CI 0.17-0.91; p = 0.03). HCC recurrence was not significantly different between the DAA and No DAA groups (HR 0.70; 95% CI 0.44-1.13; p = 0.15). A significant reduction in the rate of hepatic decompensation was observed in the DAA group compared with the No DAA group (HR 0.32; 95% CI 0.13-0.84; p = 0.02). In the DAA group, sustained virologic response was a significant predictor of OS (HR 0.02; 95% CI 0.00-0.19; p