Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy

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• 作者：Marí ; a Reig¹ ; ^&dagger ; ; Zoe Mariñ ; o² ; ^&dagger ; ; Christie Perelló ; ³ ; Mercedes Iñ ; arrairaegui⁴ ; Andrea Ribeiro¹ ; Sabela Lens² ; Alba Dí ; az⁵ ; Ramó ; n Vilana⁶ ; Anna Darnell⁶ ; Marí ; a Varela⁷ ; Bruno Sangro⁴ ; José ; Luis Calleja³ ; Xavier Forns² ; ^&Dagger ; ; Jordi Bruix¹ ; ^&Dagger ; ; ^{jbruix@clinic.ub.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HCV ; hepatitis C virus ; DAA ; direct-acting antivirals ; SVR ; sustained virological response ; MELD ; model for end-stage liver disease ; HCC ; hepatocellular carcinoma ; BCLC ; Barcelona Clinic Liver Cancer group ; LOD ; limit of detection ; EOT ; end of treatment ; SVR12 ; sustained virological response 12  ; weeks after treatment interruption ; SVR4 ; sustained virological response 4  ; weeks after treatment interruption ; MR ; magnetic resonance ; CT ; computed tomography ; TACE ; transarterial chemoembolizat
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：65
• 期：4
• 页码：719-726
• 全文大小：1015 K

文摘

The success of direct-acting antivirals (DAA) against hepatitis C is a major breakthrough in hepatology. Until now, however, there are very few data on the effect of hepatitis C virus (HCV) eradication in patients who have already developed hepatocellular carcinoma.

Methods

The study included patients with HCV infection and prior history of treated hepatocellular carcinoma who achieved complete response and lacked ‘non-characterized nodules’ at the time they underwent anti-HCV treatment with all-oral DAAs in 4 hospitals. Patients receiving interferon as part of the antiviral regimen were excluded. The baseline characteristics, laboratory and radiologic tumor response were registered in all patients before starting antiviral therapy and during the follow-up according to the clinical practice policy.

Results

Between 2014 and 2015, 103 patients with prior hepatocellular carcinoma received DAA, 58 of them met the inclusion criteria. After a median follow-up of 5.7 months, 3 patients died and 16 developed radiologic tumor recurrence (27.6%). The pattern of recurrence was: intrahepatic growth (3 patients), new intrahepatic lesion (1 nodule in 5 patients, up to 3 nodules less or equal to 3 cm in 4 cases and multifocal in one patient) and infiltrative ill-defined hepatocellular carcinoma and/or extra-hepatic lesions in 3 patients.

Conclusions

Our data show an unexpected high rate and pattern of tumor recurrence coinciding with HCV clearance and, although based in a very small cohort of patients, should be taken as a note of caution and prime a large scale assessment that exceeds the individual investigators capacity.

Lay summary

High rate of cancer recurrence after DAA treatment in patients with prior hepatocellular carcinoma. Disruption of immune surveillance may facilitate the emergence of metastatic clones.