HCV感染者接受直接抗病毒药物治疗肝细胞癌风险变化

A comparison between HCV-related hepatocellular carcinoma patients with or without direct acting antivirals treatment

目的评价丙型肝炎病毒(HCV)感染者接受直接抗病毒药物(DAA)治疗肝细胞癌(HCC)风险变化。方法2018年3月至2021年6月兰考第一医院接受治疗的HCV相关HCC病例73例。根据是否应用DAA治疗分为DAA组21例,非DAA组52例。比较HCV相关HCC病例基线资料、肿瘤学特征以及肿瘤分期情况(BCLC分期、TNM分期和CLIP评分)。结果DAA组腹痛、腹水、下肢水肿、黄疸及乏力分别为16例(76.2%)、2例(9.5%)、1例(4.8%)、1例(4.8%)及1例(4.8%);非DAA组分别为17例(32.7%)、15例(28.8%)、11例(21.1%)、9例(17.3%)及0,差异有统计学意义(P<0.05)。DAA组门静脉血栓10例(47.6%),高于非DAA组的12例(23.1%)(P<0.05);DAA组淋巴结转移6例(28.6%),高于非DAA组的3例(5.8%)(P<0.05)。DAA组BCLC 0、A、B、C、D分期分别为2例(9.5%)、2例(9.5%)、3例(14.3%)、9例(42.8%)及5例(23.8%),非DAA组分别为6例(11.5%)、19例(36.5%)、16例(30.8%)、4例(7.7%)及7例(13.5%),差异有统计学意义(P<0.05);DAA组TNMⅠ、Ⅱ、Ⅲ、Ⅳ分期分别为2例(9.5%)、3例(14.3%)、10例(47.6%)及6例(28.6%),非DAA组分别为27例(51.9%)、12例(23.1%)、8例(15.4%)及5例(9.6%),差异有统计学意义(P<0.05);DAA组CLIP评分0、1、2、3、4~6分为2例(9.5%)、5例(23.8%)、2例(9.5%)、3例(14.3%)及9例(42.8%),非DAA组分别为12例(23.1%)、15例(28.8%)、11例(21.1%)、13例(25.0%)及1例(1.9%),差异有统计学意义(P<0.05)。结论接受DAA治疗的CHC病例需要接受长期HCC监测。

Objective To compare the hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)in patients with or without receiving direct antiviral antivirals(DAAs).Methods Seventy three cases of HCV-related HCC enrolled from March 2018 to June 2021 were reviewed,including 58 males and 15 females,aged 56(44,76)years.They were divided into a DAAs group and a non-DAAs group according to whether DAAs treatment had been applied or not.The diagnosis of the disease met the requirements.The baseline data,oncological features and tumor stages(BCLC stage,TNM stage and CLIP score)of HCV-related HCC cases were collected and compared.Results There were 21 cases in DAAs group and 52 cases in non-DAAs group respectively.Abdominal pain,ascites,lower limb edema,jaundice and fatigue in DAAs group were 16 cases(76.2%),2 cases(9.5%),1 case(4.8%),and 1 case(4.8%),respectively,which were significantly different with those of 1 case(4.8%),17 cases(32.7%),15 cases(8.8%),11 cases(21.1%),9 cases(17.3%),0 case(0)in non-DAAs group(P<0.05).There were 10 cases(47.6%)of portal vein thrombosis in DAAs group,which were significantly higher than those of 12 cases(23.1%)in non-DAAs group(P<0.05).There were 6 cases(28.6%)of Lymph node metastasis in DAAs group,which were significantly higher than those of 3 cases(5.8%)in non-DAAs group[P<0.05].The BCLC stages(0,A,B,C,D)in DAAs group were 2 cases(9.5%),2 cases(9.5%),3 cases(14.3%),9 cases(42.8%)and 5 cases(23.8%)in each stage,while those in non-DAAs group were 6 cases(11.5%),19 cases(36.5%),16 cases(30.8%),4 cases(7.7%),and 7 cases(13.5%),respectively,the difference was statistically significant(P<0.05).The TNM stages(Ⅰ,Ⅱ,Ⅲ,Ⅳ)in DAAs group were 2 cases(9.5%),3 cases(14.3%),10 cases(47.6%)and 6 cases(28.6%)in each stage,while those in non-DAAs group were 27 cases(51.9%),12 cases(23.1%)and 8 cases(15.4%),respectively,the difference was statistically significant(P<0.05).The CLIP scores(0,1,2,3,4~6)of DAAs group were 2(9.5%),5(23.8%),2(9.5%),3(14.3%)and 9(42.8%),while those of non-DAAs group were 12(23.1%),15(28.8%),11(21.1%),13(25.0%),and 1(1.9%),respectively,the difference was also statistically significant(P<0.05).Conclusion Chronic hepatitis C patients need long-term HCC monitoring even after DAAs treatment.