Interferon-free therapy of chronic hepatitis C with direct-acting antivirals does not change the short-term risk for de novo hepatocellular carcinoma in patients with liver cirrhosis
Interferon-free therapy of chronic hepatitis C with direct-acting antivirals does not change the short-term risk for de novo hepatocellular carcinoma in patients with liver cirrhosis
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DOI：
10.1111/apt.14427
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发表时间：
2018-02-01
影响因子：
7.6
通讯作者：
Wedemeyer, H.
中科院分区：
文献类型：
--
作者：
Mettke, F.;Schlevogt, B.;Wedemeyer, H.
背景：以干扰素为基础的治疗清除丙型肝炎病毒（HCV）可降低肝细胞癌（HCC）的发病率。有一些争论，如果干扰素免费治疗与直接作用的抗病毒药物改变的风险为hcch.Aim：探讨肝细胞癌的发病率在丙型肝炎患者清除丙型肝炎病毒与直接作用的抗病毒药物与未经治疗的controls.Methods：我们前瞻性地监测373例慢性丙型肝炎患者谁收到了干扰素免费治疗与直接作用的抗病毒药物后，2014年1月。我们从2007年至2013年期间在我们中心接受随访的3715例HCV患者中招募了一个回顾性对照队列的未经治疗的肝硬化患者，这些患者具有类似的HCC筛查protocols.Results：158例直接作用的抗病毒治疗和184例对照肝硬化患者被纳入本分析。各组在性别和基因型分布、肝病严重程度和糖尿病患病率方面没有差异。患者的中位随访时间为440（范围91-908）天和592（范围90-1000）天。在随访期间，分别有6例和14例患者发生HCC，导致HCC发生率为2.90 vs 4.48/100人-年。在直接作用的抗病毒治疗组中，在治疗开始后450天内没有新的HCC病例。在多变量分析中，较高的MELD评分和AFP水平与HCC的发展独立相关。无移植患者的生存率在两个groups.Conclusions：干扰素免费的直接作用的抗病毒治疗慢性丙型肝炎并没有改变肝硬化患者肝癌的短期风险。在超过1.5年的随访后，HCC发病率的降低可能变得明显。
Background: Hepatitis C virus (HCV) clearance with IFN-based therapies reduces the incidence of hepatocellular carcinoma (HCC). There has been some debate if IFN-free therapy with direct-acting antivirals alters the risk for HCC.Aim: To investigate the HCC incidence in cirrhotic HCV patients who cleared HCV with direct-acting antivirals vs untreated controls.Methods: We prospectively monitored 373 patients with chronic hepatitis C who received IFN-free therapies with direct-acting antiviral after January 2014. A retrospective control cohort of untreated cirrhotic patients was recruited out of 3715 HCV patients who were followed at our centre between 2007 and 2013, with similar HCC screening protocols.Results: 158 direct-acting antiviral-treated and 184 control patients with liver cirrhosis were included in this analysis. The groups did not differ in gender and genotype distribution, severity of liver disease and prevalence of diabetes mellitus. Patients were followed up for a median of 440 (range 91-908) and 592 (range 90-1000) days. HCCs developed in 6 and 14 patients during follow-up, resulting in an incidence of 2.90 vs 4.48 HCCs per 100 person-years. In the direct-acting antiviraltreated group, there was no new case of HCC later than 450 days after treatment initiation. In multivariate analysis, higher MELD-Scores and AFP-levels were independently associated with HCC development. Transplant-free patient survival was similar in both groups.Conclusions: IFN-free direct-acting antiviral therapy of chronic hepatitis C does not alter the short-term risk for HCC in patients with liver cirrhosis. A reduced HCC incidence may become evident after more than 1.5 years of follow-up.