抗病毒治疗与丙型肝炎病毒相关肝细胞癌的关系研究进展

Research progress on the relationship of antiviral therapy with HCV-hepatocellular carcinoma

慢性丙型肝炎病毒(HCV)呈世界流行趋势,是导致肝硬化和肝细胞癌(HCC)的主要原因之一。抗HCV治疗经历了聚乙二醇化干扰素联合利巴韦林(PR方案)及直接抗病毒药物(DAA)两个时代。总体而言,通过抗病毒治疗获得持续病毒学应答(SVR)可降低HCV相关HCC的发生率,但近年来关于DAA治疗可能增高HCC发生率或复发率的报道引起了学者们的广泛关注。本文对经PR方案及DAA治疗后导致HCC发生或复发,以及HCC发生危险因素的相关文献进行综述,探讨DAA治疗后发生HCC的机制以及HCC对DAA疗效的影响,旨在帮助临床医师确定启动抗病毒治疗的时机及实施个体化管理。

Chronic hepatitis C virus(HCV)is a worldwide epidemic and the main cause of liver cirrhosis and hepatocellular carcinoma(HCC).The anti-HCV treatment has gone through two eras of pegylated interferon-αplus ribavirin(PR therapy)and direct-acting antiviral agent(DAA).Generally,achieving a sustained virological response(SVR)can reduce the incidence of HCC through antiviral treatment.In recent years,increasing researchers pay more attention to the issue whether DAA treatment might increase the risk of HCC occurrence or recurrence.This article aims to review the related studies on the risk of HCC after PR therapy and DAA treatment,summarize the risk factors,and explore the mechanism of HCC and its impact on the efficacy of DAA,in order to help clinicians to determine the timing of initiation of antiviral therapy and provide clinical evidence for individualized management.