Introduction: The impact of direct antiviral agents (DAAs) on the development of hepatocellular carcinoma (HCC) is controversial. One important aspect of this controversy is the changing pattern of HCC. Objective: In this study, we attempted to assess the changes in the pattern of HCC after treatment with DAAs. Methods: A total of 51 HCC patients after DAA treatment and 54 HCC patients without DAA treatment were included. The diagnosis of HCC was based on typical dynamic CT and/or MRI criteria in both groups. Liver status was assessed by means of the fibrosis 4 index (Fib-4), Child-Pugh classification, and model for end-stage liver disease (MELD). HCC infiltrative pattern, portal vein thrombosis (PVT), local and distant metastases, and α-fetoprotein (AFP) level were compared in the 2 groups. The staging of HCC and treatment decisions were made in both groups following the Milan criteria, Barcelona Clinic Liver Cancer staging, tumor-node-metastasis staging, and Cancer of the Liver Italian Program categorization. Results: The mean age of the HCC patients after DAA treatment (59.1± 7.4 years) was older than that of the HCC patients without DAA treatment. There was no significant difference between groups regarding sex distribution. The mean Fib-4 score (4.84 ± 3.53) was significantly lower in HCC patients after DAA treatment than in those without DAA treatment. The frequency of the infiltrative HCC pattern, PVT, and regional lymph node metastasis was significantly higher in HCC patients after DAA treatment than in those without DAA treatment (p ≤ 0.05); mean AFP level (5,085.2 ± 11,883.2 ng/mL) was also significantly higher. HCC patients after DAA treatment had significantly advanced stages and limited treatment options (p ≤ 0.05). Conclusion: The changing HCC pattern after DAA treatment may suggest the need for new HCC staging and treatment protocols.
Gastrointest Tumors 2020;7:50–59

中文翻译：

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直接抗病毒药物治疗后肝细胞癌模式的改变。

简介：直接抗病毒药物 (DAA) 对肝细胞癌 (HCC) 发展的影响存在争议。这场争论的一个重要方面是 HCC 的变化模式。目的：在本研究中，我们试图评估 DAA 治疗后 HCC 模式的变化。方法：共纳入 51 例接受 DAA 治疗的 HCC 患者和 54 例未接受 DAA 治疗的 HCC 患者。HCC的诊断基于两组典型的动态CT和/或MRI标准。通过纤维化 4 指数 (Fib-4)、Child-Pugh 分类和终末期肝病模型 (MELD) 评估肝脏状态。比较2组HCC浸润模式、门静脉血栓形成(PVT)、局部和远处转移、甲胎蛋白(AFP)水平。两组的 HCC 分期和治疗决策均遵循米兰标准、巴塞罗那诊所肝癌分期、肿瘤-淋巴结转移分期和意大利肝癌项目分类。结果：DAA 治疗后 HCC 患者的平均年龄（59.1±7.4 岁）大于未接受 DAA 治疗的 HCC 患者。在性别分布方面，各组之间没有显着差异。DAA 治疗后 HCC 患者的平均 Fib-4 评分 (4.84 ± 3.53) 显着低于未接受 DAA 治疗的患者。DAA治疗后HCC患者浸润性HCC模式、PVT和区域淋巴结转移的频率显着高于未接受DAA治疗的患者（p≤0.05）；平均 AFP 水平 (5,085.2 ± 11,883.2 ng/mL) 也显着升高。DAA 治疗后的 HCC 患者具有明显的晚期阶段和有限的治疗选择（p ≤ 0.05）。结论：DAA 治疗后不断变化的 HCC 模式可能表明需要新的 HCC 分期和治疗方案。
胃肠肿瘤 2020；7:50–59