Yeo W, Lam K C, Zee B, Chan P S K, Mo F K F, Ho W M, Wong W L, Leung T W T, Chan A T C, Ma B, Mok T S K, Johnson P J
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Ann Oncol. 2004 Nov;15(11):1661-6. doi: 10.1093/annonc/mdh430.
Cancer patients who are hepatitis B virus (HBV) carriers and undergoing chemotherapy (CT) may be complicated by HBV reactivation. Over 80% of hepatocellular carcinoma (HCC) patients are HBV carriers; however, the incidence of HBV reactivation during CT has not been well-reported. A prospective study was conducted to determine the incidence of HBV reactivation, the associated morbidity and mortality, and possible risk factors.
102 HBsAg-positive patients with inoperable HCC underwent systemic CT. Patients received either combination cisplatin, interferon, doxorubicin and fluorouracil (PIAF) or single-agent doxorubicin. They were followed up during and for 8 weeks after CT.
In 102 patients, 59 (58%) developed hepatitis amongst whom 37 (36%) were attributable to HBV reactivation. Twelve (30%) died of HBV reactivation. CT was interrupted in 32 patients (86%) with reactivation and 54 (83%) without reactivation (P>0.05). The median survivals were 6.00 and 5.62 months, respectively (P=0.694). Elevated baseline alanine aminotransferase (ALT) was found to be a risk factor.
HBV reactivation is a common cause of liver damage during CT in HBsAg-positive HCC patients. The only identifiable associated risk factor was elevated pre-treatment ALT. Further studies into the role of antiviral and novel anticancer therapies are required to improve the prognosis of these patients.
乙肝病毒（HBV）携带者且正在接受化疗（CT）的癌症患者可能会并发HBV再激活。超过80%的肝细胞癌（HCC）患者是HBV携带者；然而，CT期间HBV再激活的发生率尚未得到充分报道。开展了一项前瞻性研究以确定HBV再激活的发生率、相关的发病率和死亡率以及可能的危险因素。
102例HBsAg阳性的无法手术切除的HCC患者接受了全身CT。患者接受顺铂、干扰素、阿霉素和氟尿嘧啶联合方案（PIAF）或单药阿霉素治疗。在CT期间及之后8周对他们进行随访。
102例患者中，59例（58%）发生肝炎，其中37例（36%）归因于HBV再激活。12例（30%）死于HBV再激活。32例（86%）再激活患者和54例（83%）未再激活患者的CT治疗中断（P>0.05）。中位生存期分别为6.00个月和5.62个月（P=0.694）。发现基线丙氨酸氨基转移酶（ALT）升高是一个危险因素。
HBV再激活是HBsAg阳性HCC患者CT期间肝损伤的常见原因。唯一可识别的相关危险因素是治疗前ALT升高。需要进一步研究抗病毒和新型抗癌疗法的作用，以改善这些患者的预后。
