目的：HCV感染已被认为是原发性肝癌术后再发的潜在危险因素。然而,鲜为人知的是，丙肝病毒载量对外科手术效果的影响。这项研究的目的是探讨丙型肝炎病毒载量在原发性肝癌长期预后的临床意义。 患者和方法：370名被分为ChildA和接受治疗肝切除术，与丙肝性肝癌相关的患者分为低和高病毒载量组(≤或>?)，这是基于最低P值的方法来预测中度到重度的活动性肝炎;然后比较临床结果。结果：在低病毒载量组，5年再发率为36.1%，而在高病毒载量组为12.4%。5年总体生存率在高病毒载量组为76.6%。多变量分析证实显著相关性高病毒载量和肿瘤复发与危险比为1.87(95%可信区间,1.41到2.48;)。亚分析提示在低病毒载量组有利的结果并非归因于是否得到根除丙肝病毒血清学无论是在原发还是继发性感染。结论：低丙肝病毒载量预测更好的长期肝癌患者手术治疗结果不考虑血清学根除丙肝病毒。
吉林大学第一医院呼吸内科 闫瑞华 摘译
本文首次发表于[J Clin Oncol. 2012 Nov 5]
Low Hepatitis C Viral Load Predicts Better Long-Term Outcomes in Patients Undergoing Resection of Hepatocellular Carcinoma Irrespective of Serologic Eradication of Hepatitis C Virus
PURPOSE：Hepatitis C virus (HCV) infection has been recognized as a potent risk factor for the postoperative recurrence of hepatocellular carcinoma (HCC). However, little is known about the impact of HCV viral load on surgical outcomes. The study objective was to investigate clinical significance of HCV viral load on long-term outcomes of HCC. PATIENTS AND METHODS： Three hundred seventy patients who were classified as Child-Pugh class A and underwent curative liver resections for HCV-related HCC were divided into low and high viral load groups (≤ or > 5.3 log(10)IU/mL) based on the results of a minimum P value approach to predict moderate to severe activity of hepatitis; the clinical outcomes were then compared. Results：The 5-year recurrence-free survival rate was 36.1% in the low viral load group and 12.4% in the high viral load group (P < .001). The 5-year overall survival rate was 76.6% in the low viral load group and 57.7% in the high viral load group (P < .001). Multivariate analysis confirmed significant correlation between high viral load and tumor recurrence with a hazard ratio of 1.87 (95% CI, 1.41 to 2.48; P < .001). Subanalysis revealed that the favorable results in the low viral load group were not attributed to whether or not serologic eradication of HCV was obtained both in primary and recurrent lesions. CONCLUSION： Low HCV viral load predicts better long-term surgical outcomes in patients with HCC regardless of the serologic eradication of HCV. 
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