Yeo Winnie, Mo Frankie K F, Chan Stephen L, Leung Nancy W Y, Hui Pun, Lam Wai-Yip, Mok Tony S K, Lam Kowk C, Ho Wing M, Koh Jane, Tang Julian W, Chan Anthony T, Chan Paul K S
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Hepatology. 2007 Jun;45(6):1382-9. doi: 10.1002/hep.21572.
HCC is a common cause of morbidity and mortality. For patients who are not candidates for curative surgery, systemic chemotherapy is one of the standard treatments. In parts of China and the Far East, over 80% of HCC patients have chronic HBV infection. In this study, we aimed to assess the relationship between pre-chemotherapy HBV viral load and the survival of HCC patients. HBV infection status was determined prior to chemotherapy in 188 patients, 170 of whom had evidence of HBV chronic infection/exposure (160 hepatitis B surface antigen [HBsAg]-positive, 10 HBsAg-negative/hepatitis B core antibody-positive). Of these, 125 had pretreatment HBV DNA levels determined via real-time PCR. Virological data were analyzed using conventional clinical variables to identify factors that influenced survival. Multivariate analysis revealed that high total bilirubin (P = 0.0016; hazard ratio = 1.040 per 1 muM increase; 95% CI 1.015-1.065), HCV infection (P = 0.0095; hazard ratio = 6.955; 95% CI 1.606-30.129), and high HBV DNA level (P = 0.0217; hazard ratio = 1.650; 95% CI 1.076-2.531) affected survival significantly. Exploratory analysis revealed that high levels of pretreatment HBV DNA had a significantly higher incidence of severe hepatitis during chemotherapy.
For HCC patients with HBV chronic infection/exposure, a high viral load prior to treatment is an adverse factor for survival and may be associated with a higher incidence of severe hepatitis during chemotherapy. Future strategies to improve the prognosis of HCC patients undergoing chemotherapy should consider supportive therapy that incorporates antiviral therapies to reduce HBV viral load.
肝癌是发病和死亡的常见原因。对于不适合进行根治性手术的患者，全身化疗是标准治疗方法之一。在中国部分地区和远东地区，超过80%的肝癌患者患有慢性乙肝病毒感染。在本研究中，我们旨在评估化疗前乙肝病毒载量与肝癌患者生存率之间的关系。在188例患者化疗前确定了乙肝病毒感染状态，其中170例有慢性乙肝病毒感染/暴露的证据（160例乙肝表面抗原[HBsAg]阳性，10例HBsAg阴性/乙肝核心抗体阳性）。其中，125例通过实时聚合酶链反应测定了治疗前乙肝病毒DNA水平。使用传统临床变量分析病毒学数据，以确定影响生存的因素。多因素分析显示，高总胆红素（P = 0.0016；风险比 = 每增加1 μM增加1.040；95%置信区间1.015 - 1.065）、丙肝病毒感染（P = 0.0095；风险比 = 6.955；95%置信区间1.606 - 30.129）和高乙肝病毒DNA水平（P = 0.0217；风险比 = 1.650；95%置信区间1.076 - 2.531）对生存有显著影响。探索性分析显示，治疗前乙肝病毒DNA水平高的患者在化疗期间发生严重肝炎的发生率显著更高。
对于慢性乙肝病毒感染/暴露的肝癌患者，治疗前高病毒载量是生存的不利因素，可能与化疗期间严重肝炎的发生率较高有关。未来改善接受化疗的肝癌患者预后的策略应考虑采用包含抗病毒治疗以降低乙肝病毒载量的支持性治疗。
