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比较乙型肝炎和丙型肝炎病毒相关性肝细胞癌患者行切除术的预后。

A comparison of prognosis between patients with hepatitis B and C virus-related hepatocellular carcinoma undergoing resection surgery.

机构信息

Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

World J Surg. 2011 Apr;35(4):858-67. doi: 10.1007/s00268-010-0928-z.

Abstract

BACKGROUND

The impact of viral factors on the prognosis of hepatocellular carcinoma (HCC) remains controversial because of heterogeneous populations included in previous reports. This study aims to compare clinicopathologic features and prognoses between patients with hepatitis B- and hepatitis C-related HCC who underwent resection surgery.

METHODS

We enrolled 609 patients with positive serum hepatitis B virus (HBV) surface antigen (HBsAg) and negative serum antibody against hepatitis C virus (anti-HCV) as the B-HCC group and 206 patients with negative serum HBsAg and positive anti-HCV as the C-HCC group. The overall survival rates and cumulative recurrence rates were compared between these two groups.

RESULTS

B-HCC patients were significantly younger, predominantly male, had better liver functional reserve, but more advanced tumor stage than C-HCC patients. After a median follow-up period of 40.6 months, 427 patients had died. Furthermore, 501 patients had tumor recurrence after surgery. The postoperative overall survival rates (p = 0.640) and recurrence rates (p = 0.387) of the two groups were comparable. However, the overall survival rate was higher in the B-HCC group than in the C-HCC group in the cases of transplantable HCC (p = 0.021) and Barcelona-Clinic Liver Cancer stage A HCC (p = 0.040).

CONCLUSIONS

Viral etiologies were not apparent in determining outcomes of HCC patients who underwent resection due to heterogeneous studied populations. In early-stage HCC, B-HCC patients had better outcomes than C-HCC patients did because of better liver reserve and less hepatic inflammation.

摘要

背景

由于之前的报道纳入了异质人群,病毒因素对肝细胞癌(HCC)预后的影响仍存在争议。本研究旨在比较接受肝切除术的乙型肝炎和丙型肝炎相关 HCC 患者的临床病理特征和预后。

方法

我们纳入了 609 例血清乙型肝炎病毒(HBV)表面抗原(HBsAg)阳性和血清丙型肝炎病毒抗体(抗-HCV)阴性的患者作为 B-HCC 组,以及 206 例血清 HBsAg 阴性和抗-HCV 阳性的患者作为 C-HCC 组。比较两组患者的总生存率和累积复发率。

结果

B-HCC 患者明显更年轻,男性居多,肝功能储备更好,但肿瘤分期更晚。中位随访 40.6 个月后,有 427 例患者死亡。此外,术后有 501 例患者发生肿瘤复发。两组患者的术后总生存率(p = 0.640)和复发率(p = 0.387)相当。然而,在可移植性 HCC(p = 0.021)和巴塞罗那临床肝癌分期 A 期 HCC(p = 0.040)中,B-HCC 组的总生存率高于 C-HCC 组。

结论

由于研究人群异质性,病毒病因在确定接受肝切除术的 HCC 患者的结局方面并不明显。在早期 HCC 中,由于更好的肝功能储备和较少的肝炎症,B-HCC 患者的预后优于 C-HCC 患者。

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