Novel direct antiviral-acting (DAA) molecules significantly improved efficacy and ameliorated outcomes of patients with chronic hepatitis C (CHC). The extensive use of DAA from 2015, due to large access to therapy, maximized rates of viral eradication with a safety profile in the majority of cases. Aims: We evaluated risk factors and the incidence of related clinical events and hepatocellular carcinoma (HCC) in cases with sustained virologic response (SVR) after DAA. We also aimed to apply a score assessment to identify the individual patient with unfavorable outcomes during an average follow-up (FU) of five years. Methods: In total, 470 cases consecutively recruited with CHC have been compared by non-invasive tests (NIT), as APRI, FORNS, FIB-4, LSPS, and transient elastography (TE) liver stiffness measurement (LSM), to identify cutoff related to major event onset. Results: Grouping of cases without or with related events development of both types hepatic (HE) (i.e., HCC or further cirrhosis decompensation or/with hospitalized septic state) or extrahepatic (EHE) (i.e., other tumors, bleeding, or thrombotic episodes and other organs pathologic conditions not liver related)allowed us to select the parameters to propose a novel risk stratification system (RISS) for the identification of the remnant individual patient’s risk for HCC occurrence, orthotopic liver transplant (OLT) need, or death during long-term follow-up (FU). Conclusions: Patients with cirrhosis and portal hypertension (PH) maintained a higher LSM mean value (>25 kPa), showed the lowest reduction of NIT scores, and developed events in 80/108 (74%) cases (67 and 13 of HE and EHE type), even after long-term successful DAA therapy. Furthermore, cases with RISS score ≥ 8 demonstrated a significant incidence of HCC (37/46, 80.4%) and a reduction in survival rate to 65.4% at 5-year FU.
新型直接抗病毒药物显著提升了慢性丙型肝炎患者的治疗效果并改善了预后。自2015年起，由于治疗可及性大幅提高，直接抗病毒药物被广泛应用，在多数病例中实现了病毒清除率的最大化，且安全性良好。研究目的：评估直接抗病毒药物治疗获得持续病毒学应答后相关临床事件及肝细胞癌发生的风险因素与发病率，并尝试通过评分系统识别平均五年随访期内预后不良的个体患者。研究方法：连续纳入470例慢性丙型肝炎患者，通过非侵入性检测（如APRI、FORNS、FIB-4、LSPS评分及瞬时弹性成像肝脏硬度测量）进行比较分析，确定与主要事件发生相关的截断值。研究结果：根据是否发生肝脏相关事件（如肝细胞癌、肝硬化失代偿或/伴脓毒症住院）或肝外事件（如其他肿瘤、出血或血栓事件及其他非肝脏器官病理状况）对病例进行分组，据此筛选参数构建新型风险分层系统，用于识别长期随访期间肝细胞癌发生、需行原位肝移植或死亡风险的残留个体患者。研究结论：即使经过长期成功的直接抗病毒治疗，合并肝硬化与门静脉高压的患者仍维持较高的平均肝脏硬度值（>25 kPa），其非侵入性检测评分降幅最小，且在80/108例（74%）中发生临床事件（其中肝脏事件67例，肝外事件13例）。此外，风险分层系统评分≥8的病例中，肝细胞癌发病率显著升高（37/46，80.4%），五年随访生存率降至65.4%。
肿瘤(癌症)患者之家