【文献解读】抗病毒在丙型肝炎和肝癌治疗应用中所面临的难题
2018/2/25 创新医学网

    

    

     文章来源:欧尔意 OAE 微信号

     作者 :sofina

    

     原文出处

     Buonfiglioli F, Brillanti S. Direct antiviral therapy for hepatitis C and hepatocellular carcinoma: facing the conundrum. Hepatoma Res 2018;4:6. http://dx.doi.org/10.20517/2394-5079.2017.42

     DOI: 10.20517/2394-5079.2017.42

     摘要

     抗病毒治疗已经很大程度上提高了我们在慢性肝病各阶段根除丙型肝炎病毒(HCV)的可能性,持续病毒学应答率远高于90%。即使发展为肝硬化,HCV病毒的根除也会使患者受益,降低患者发展为肝癌的风险。不幸的是,在过去的两年里,许多研究者提出抗病毒药物可能会增加肝硬化患者发生肝癌的风险。在这篇综述中,我们评估了已发表的主要研究数据并得出以下结论:(1) 直接抗病毒治疗似乎不会增加肝癌总体年发病率和复发率;(2)但抗病毒治疗结束不久似乎会加速肝癌的发病及进展,特别是那些处于肝癌发病或复发高风险的患者;(3) 初步报告显示在抗病毒治疗后肝癌的侵袭性似乎更强。这些发现表明有必要在抗病毒治疗期间和之后对肝硬化患者进行积极和密切的监测,以便尽早发现和治疗早期肝癌。

     关键词:直接抗病毒治疗,肝细胞癌,肝硬化,风险,丙肝

     Abstract:Direct antiviral therapy has dramatically changed our possibility to eradicate hepatitis C virus (HCV) infection in all stages of chronic liver disease, with sustained virological response rates well above 90%. HCV eradication should lead to a better prognosis even after cirrhosis has established, including a reduced risk of developing hepatocellular carcinoma (HCC). Unfortunately, during the last two years different reports have raised the concern about a possible increased risk of developing HCC in cirrhotic patients treated with direct antivirals. In this review, we have evaluated the principal published data and have reached a few conclusions: (1) direct antiviral therapy does not seem to increase the cumulative annual rate of HCC de novo occurrence or recurrence; (2) direct antiviral therapy seems to accelerate the development of HCC, soon after the end of treatment, in those patients at higher risk of HCC occurrence or recurrence; and (3) preliminary reports seem to indicate that HCC developed after direct antiviral therapy has more aggressive features. These findings clearly indicate the need for aggressive and close monitoring of cirrhotic patients during and after antiviral treatment, to detect and treat HCC at their earliest occurrence.

     Keywords: Direct-acting antivirals, hepatocellular carcinoma, liver cirrhosis, risk, hepatitis C

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