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J Hepatol:DAA治疗晚期肝纤维化的HCV患者,其新生HCC的发生率

2018-07-25 MedSci MedSci原创

这些数据是在一项大规模、前瞻性、基于人群的研究中获得的,在接受DAAs治疗的晚期丙型肝炎患者中,第一年发生"新生"肝癌的风险并不比未经治疗的患者高,也可能更低。此后风险进一步下降。早期肝癌的外观可能反映先前存在的、显微的、不可检测的肿瘤。

研究背景:直接抗病毒药物(DAAs)对丙型肝炎患者是安全有效的。本研究的目的是评估晚期丙型肝炎患者接受DAAs治疗后,新诊断的肝癌的发生率及相关危险因素。

研究方法:该项研究基于NAVIGATORE平台,该平台是一个前瞻性记录了意大利威尼托地区所有接受DAAs药物的丙型肝炎患者的数据库。研究纳入标准为肝纤维化分期≥F3。排除标准为:Child-Turcotte-Pugh (CTP)-C、DAAs治疗前进行过肝移植、HCC病史或存在史、启动DAAs后随访<4周。在4234例患者中,总共有3917例患者被纳入该研究,平均随访时间为536.2±197.6天。

研究结果:总的来说,55例患者中被诊断出HCC。第一年,肝纤维化3期患者发生HCC的比率为0.46% (95% CI 0.12-1.17),CTP-A级的患者发生HCC的比率为1.49% (1.03-2.08),CTP-B肝硬化患者HCC发生比率为3.61% (1.86-6.31);第二年,肝癌的发生率分别为0%、0.2%和0.69%。多因素分析表明,HCC与天冬氨酸氨基转移酶/血小板比率≥2.5(危险比[HR]: 2.03; 95%可信区间1.14-3.61;(p=0.016)和乙肝病毒感染(HR 3.99);1.24-12.91; p = 0.021)相关。未能获得病毒学应答与HCC的发展密切相关(HR 9.09; 5.2-16.1; p = 0.0001)。在HCC患者中,29%的患者存在侵袭性肿瘤,通常在治疗的早期出现

研究结论:这些数据是在一项大规模、前瞻性、基于人群的研究中获得的,在接受DAAs治疗的晚期丙型肝炎患者中,第一年发生"新生"肝癌的风险并不比未经治疗的患者高,也可能更低。此后风险进一步下降。早期肝癌的外观可能反映先前存在的、显微的、不可检测的肿瘤。

原始出处:

Romano A, Angeli P, Piovesan S, et al. Newly diagnosed hepatocellular carcinoma in patients with advanced hepatitis C treated with DAAs: A prospective population study. J Hepatol, 2018, 69(2), 345-352.

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    2018-07-27 ymljack
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    2018-07-27 jiyangfei
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    2018-07-27 qingting
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    2018-07-27 gwc384

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