首先是什么：治疗病毒性肝炎或肝癌？

StephenW

Digestive Diseases and Sciences

April 2019, Volume 64, Issue 4, pp 1041–1049 | Cite as
What Comes First: Treatment of Viral Hepatitis or Liver Cancer?

    Authors
    Authors and affiliations

    Jordan J. FeldEmail authorLisette A. P. Krassenburg

    Jordan J. Feld
        1Email author
    Lisette A. P. Krassenburg
        12

    1.Toronto Centre for Liver Disease, Toronto General Hospital, Sandra Rotman Centre for Global HealthUniversity of TorontoTorontoCanada
    2.Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands

Review
First Online: 14 March 2019

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Abstract

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the most important underlying causes for the development of hepatocellular carcinoma (HCC) worldwide. Determining the optimal approach for management of the viral infection and the HCC depends on the virus and the stage of the cancer. In patients with HCV-associated HCC, there are multiple reasons to first treat the HCC. Firstly, in case of a curable HCC, the urgency for HCC treatment is important to avoid progression during HCV treatment. Secondly, the presence of HCC itself appears to reduce the rates of sustained virological response (SVR) achieved with direct-acting antivirals (DAAs). And finally, the evidence does not support the concept of an increase in HCC recurrence due to DAAs, so a patient can safely be treated after HCC cure. For patients with very advanced HCC, the benefits of HCV therapy are questionable. In contrast, those who develop HCC in the setting of chronic HBV infection, treatment with nucleoside analogues (NAs) is recommended prior to treating HCC, to prevent further liver injury and reduce the risk for HCC recurrence. Ultimately, earlier diagnosis and treatment of HBV and HCV will hopefully reduce the incidence of HCC worldwide.
Keywords
Hepatitis C virus (HCV) Sustained virological response (SVR) Hepatocellular carcinoma (HCC) Direct-acting antivirals (DAAs) Hepatitis B virus (HBV)

StephenW

消化系统疾病与科学

2019年4月，第64卷，第4期，第1041-1049页|引用为
首先是什么：治疗病毒性肝炎或肝癌？

    作者
    作者和附属机构

    Jordan J. FeldEmail作者Lisis A. P. Krassenburg

    Jordan J. Feld
        1Email作者
    Lisette A. P. Krassenburg
        12

    1.多伦多综合医院多伦多肝病中心，桑德拉罗特曼全球健康中心多伦多多伦多多伦多加拿大
    2.Erasus大学医学中心消化科和肝病学系鹿特丹荷兰

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首次在线：2019年3月14日

    1股149下载

抽象

慢性乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染是全世界肝细胞癌（HCC）发展的最重要的潜在原因。确定管理病毒感染和HCC的最佳方法取决于病毒和癌症的阶段。在HCV相关HCC患者中，首先治疗HCC有多种原因。首先，在可治愈的HCC的情况下，HCC治疗的紧迫性对于避免HCV治疗期间的进展是重要的。其次，HCC本身的存在似乎降低了用直接作用抗病毒药物（DAA）实现的持续病毒学应答（SVR）的速率。最后，证据不支持DAA引起的HCC复发增加的概念，因此患者可以在HCC治愈后安全地接受治疗。对于非常晚期HCC患者，HCV治疗的益处值得怀疑。相反，在治疗HCC之前，建议那些在慢性HBV感染，核苷类似物（NAs）治疗中发生HCC的患者，以防止进一步的肝损伤并降低HCC复发的风险。最终，早期诊断和治疗HBV和HCV有望降低全球HCC的发病率。
关键词
丙型肝炎病毒（HCV）持续病毒学应答（SVR）肝细胞癌（HCC）直接作用抗病毒药物（DAAs）乙型肝炎病毒（HBV）

hanhou8601

肝癌治疗后 抗病毒治疗必须治疗