State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Liver Int. 2012 Feb;32(2):271-8. doi: 10.1111/j.1478-3231.2011.02634.x. Epub 2011 Aug 31.
Antiviral therapy for hepatitis B virus (HBV) infection is frequently prescribed for patients with chronic HBV infection during surveillance for hepatocellular carcinoma (HCC). In patients who subsequently develop HCC, the impact of antiviral therapy on the outcome of HCC remains unclear.
We aimed to study the impact of antiviral therapy on the survival of patients who developed HCC.
From two prospective surveillance cohorts, the use of antiviral therapy for patients with HCC was retrospectively reviewed. We compared the overall survival, liver function and tumour characteristics between patients with and without antiviral therapy during surveillance. Multivariate analysis was conducted to determine the independent prognostication of antiviral therapy.
During a median follow-up of 10.1 years of 1429 patients, 148 cases of HCC were diagnosed and followed up for a median of 5.7 years. Twenty-nine patients were given antiviral therapy during surveillance and continued treatment after diagnosis of HCC. The median survival of this group of patients was better than the rest of cohorts (hazard ratio: 0.472; 95% CI: 0.25-0.89; P = 0.0191). Use of antiviral therapy remained an independent prognostic factor after adjustment for demographic factors and tumour staging on multivariate analysis. Exploratory analysis revealed that patients who commenced antiviral therapy during surveillance had lower HBV DNA, lower serum alanine transaminase, better hepatic reserves and higher rate of local treatment at diagnosis of HCC.
This study provides evidence that commencement of antiviral therapy during the surveillance period is associated with improvement in overall survival in HBV-related HCC.
乙型肝炎病毒 (HBV) 感染的抗病毒治疗常被用于慢性 HBV 感染患者的肝细胞癌 (HCC) 监测。在随后发展为 HCC 的患者中，抗病毒治疗对 HCC 结局的影响尚不清楚。
我们旨在研究抗病毒治疗对发展为 HCC 的患者生存的影响。
从两个前瞻性监测队列中，回顾性审查了 HCC 患者抗病毒治疗的使用情况。我们比较了监测期间有和没有抗病毒治疗的患者的总生存率、肝功能和肿瘤特征。进行多变量分析以确定抗病毒治疗的独立预后因素。
在 1429 例患者的中位随访 10.1 年中，诊断出 148 例 HCC，并随访了中位 5.7 年。29 例患者在监测期间接受了抗病毒治疗，并在 HCC 诊断后继续治疗。该组患者的中位生存时间优于其余队列（风险比：0.472；95%CI：0.25-0.89；P = 0.0191）。在多变量分析中，调整了人口统计学因素和肿瘤分期后，抗病毒治疗的使用仍然是一个独立的预后因素。探索性分析显示，在监测期间开始抗病毒治疗的患者在 HCC 诊断时具有较低的 HBV DNA、较低的血清丙氨酸转氨酶、更好的肝储备和更高的局部治疗率。
本研究提供了证据，表明在监测期间开始抗病毒治疗与 HBV 相关 HCC 的总生存率提高有关。
