Antiviral therapy improves overall survival in hepatitis C virus-infected patients who develop diffuse large B-cell lymphoma
Antiviral therapy improves overall survival in hepatitis C virus-infected patients who develop diffuse large B-cell lymphoma
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DOI：
10.1002/ijc.30372
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发表时间：
2016-12-01
影响因子：
6.4
通讯作者：
Torres, Harrys A.
中科院分区：
文献类型：
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作者：
Hosry, Jeff;Mahale, Parag;Torres, Harrys A.
慢性丙型肝炎病毒感染与非霍奇金淋巴瘤的发病率增加有关。几项研究表明，仅用抗病毒治疗(AVT)可使惰性淋巴瘤消退。然而，AVT在丙型肝炎病毒感染的弥漫性大B细胞淋巴瘤(DLBCL)患者中的作用尚不清楚。因此，我们分析了AVT对发生DLBCL的丙型肝炎感染患者(病例)的肿瘤学结局的影响。将在我所就诊的病例(2004年6月至2014年5月)与未感染的病例(对照组)配对，然后根据既往的以干扰素为基础的方案组成的AVT进行分类。我们研究了304例患者(76例和228例对照)。与对照组相比，更多的病例有结外(79%比72%；p=0.07)和上消化道(42%比24%；p=0.004)受累。与对照组(50%比32%；p=0.09)或接受AVT治疗的患者(50%比27%；p=0.06)相比，从未接受AVT的患者DLBCL对一线化疗的耐受性更强(33%比17%；p=0.05)，最后一次检查显示出更多进展的淋巴瘤的趋势。从未接受过AVT的患者的5年总生存率(OS)低于对照组(HR，2.3[95%CI，1.01-5.3]；p=0.04)。此外，AVT改善了单变量(中位数[四分位数范围]：39[四分位数范围]：39[26-56]个月比16[6-41]个月，p=0.02)和多因素分析(HR=0.21[95%CI，0.06-0.69]；p=0.01)患者的5年OS率。这项研究强调了慢性丙型肝炎对DLBCL患者生存的负面影响，并表明治疗丙型肝炎病毒感染与癌症对化疗的更好反应有关，并改善了5年生存率。有什么新消息？慢性感染丙型肝炎病毒会增加患非霍奇金淋巴瘤的风险。抗病毒治疗(AVT)可能会改善与丙型肝炎病毒感染相关的几种类型的淋巴瘤的结果，但结果一直存在争议。在这项研究中，作者询问AVT是否可以使发展为弥漫性大B细胞淋巴瘤(DLBCL)的丙型肝炎病毒感染患者受益。他们发现，虽然丙型肝炎病毒感染似乎会恶化DLBCL的预后，但AVT提高了这些感染患者的五年总存活率。
Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non-Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV-infected patients with diffuse large B-cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT's impact on oncologic outcomes of HCV-infected patients (cases) who developed DLBCL. Cases seen at our institution (June 2004-May 2014) were matched with uninfected counterparts (controls) and then divided according to prior AVT consisting of interferon-based regimens. We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% vs. 72%; p=0.07) and upper gastrointestinal (GI; 42% vs. 24%; p=0.004) involvement. Cases never given AVT had DLBCL more refractory to first-line chemotherapy than that in the controls (33% vs. 17%; p=0.05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% vs. 32%; p=0.09) or cases given AVT (50% vs. 27%; p=0.06). Cases never given AVT had worse 5-year overall survival (OS) rates than did the controls (HR, 2.3 [95% CI, 1.01-5.3]; p=0.04). Furthermore, AVT improved 5-year OS rates among cases in both univariate (median [Interquartile range]: 39 [26-56] vs. 16 [6-41] months, p=0.02) and multivariate analyses (HR=0.21 [95% CI, 0.06-0.69]; p=0.01). This study highlights the negative impact of chronic HCV on survival of DLBCL patients and shows that treatment of HCV infection is associated with a better cancer response to chemotherapy and improves 5-year OS.What's new? Chronic infection with hepatitis C virus (HCV) can increase the risk of non-Hodgkin lymphoma. Treatment with antiviral therapy (AVT) may improve outcomes for several types of lymphoma associated with HCV infection, but results have been controversial. In this study, the authors asked whether AVT could benefit HCV-infected patients who developed diffuse large B-cell lymphoma (DLBCL). They found that, while HCV infection seems to worsen DLBCL prognosis, AVT improved five-year overall survival in these infected patients.