在活性肝细胞癌中重新评估DAA治疗:从争议到临床考虑
So Hyun Jeon1, Jeong-Ju Yoo1, Sang Gyune Kim1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Journal of liver cancer
|December 2, 2025
概括
直接作用的抗病毒疗法对肝癌患者来说是安全的,没有增加复发风险. 当治疗接近治愈程序或在肝移植机构之外时,就会产生最佳结果.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 在瘤学瘤学.
- 病毒学 病毒学
背景情况:
- 直接作用抗病毒疗法 (DAA) 已经彻底改变了慢性肝炎C病毒 (HCV) 管理.
- 在患有活性肝细胞癌 (HCC) 的患者中DAA的作用受到争论,早期人们对HCC复发的担忧.
- 相互矛盾的国际指导方针凸显了在HCC患者中DAA使用方面缺乏共识.
研究的目的:
- 评估直接作用抗病毒疗法对肝细胞癌复发和瘤结局的影响.
- 综合当前关于DAA在慢性型肝炎和活性HCC患者的安全性和有效性的证据.
- 为了解决DAA快速病毒清除的潜在瘤效应的争议.
主要方法:
- 对大规模的队列研究和检查DAA治疗后HCC复发率的元分析进行审查.
- 分析主要胃肠病学和肝病学协会的国际指南.
- 对瘤结局的回顾性数据的评估,包括整体和无复发生存率.
主要成果:
- 目前的证据表明,DAA可以安全地整合到HCC管理中,而没有明显的危害证据.
- 当DAA在治疗程序附近或在非移植环境中使用时,瘤治疗结果最有利.
- 涉及肝移植候选人的研究经常显示DAA在调整混杂因素后对瘤结果具有中性作用.
结论:
- 对于患有慢性型肝炎和活性HCC的患者,可以安全地进行DAA治疗.
- 个性化,多学科的决策至关重要,考虑到瘤生物学,肝功能和治疗目标.
- 需要进一步的前性研究和验证的生物标志物来优化DAA在这个人群中的使用.
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