Department of Internal Medicine, Yonsei University College of Medicine, Korea Institute of Gastroenterology, Yonsei University College of Medicine, Korea Liver Cirrhosis Clinical Research Center, Korea Brain Korea 21 Project for Medical Science, Seoul, Korea Department of Infectious Disease, Health Sciences University, Ulaanbaatar, Mongolia.
J Gastroenterol Hepatol. 2012 Sep;27(9):1528-34. doi: 10.1111/j.1440-1746.2012.07145.x.
Little information is available about the antiviral efficacy of lamivudine (LAM) and entecavir (ETV) in patients with hepatitis B virus (HBV)-related advanced hepatocellular carcinoma (HCC). Thus, we compared the antiviral efficacy of LAM and ETV in these patients.
The medical records of 134 antiviral therapy-naïve patients with HBV-related advanced HCC (modified Union for International Cancer Control [UICC] Tumor, Nodes, and Metastases [TNM] stages III-IV) treated between January 2005 and September 2009 were reviewed. After HCC diagnosis, 87 (64.9%) and 47 (35.1%) patients received LAM and ETV, respectively.
The mean age of patients (115 men, 19 women) was 53 years. Sixty-five (48.5%) and 69 (51.5%) patients had TNM stages III and IV HCC, respectively. Treatment outcomes during follow-up, including virologic, biochemical, and serologic responses and appearance of antiviral resistance, were similar in the LAM and ETV groups (all P>0.05). Multivariate analysis identified Child-Pugh class, α-fetoprotein, and TNM stage as independent predictors of overall survival (all P<0.05). Antiviral agent type (LAM vs ETV) did not influence overall survival (median 9.6 months in LAM vs 13.6 months in ETV group; P=0.493). HCC treatment was not interrupted due to HBV flare up in any patient.
The antiviral efficacy of LAM and ETV was similar and the type of antiviral agent did not influence overall survival in patients with HBV-related advanced HCC. Thus, LAM, which is less expensive than ETV in Korea, might be sufficient to control HBV in these patients.
关于拉米夫定（LAM）和恩替卡韦（ETV）在乙型肝炎病毒（HBV）相关晚期肝细胞癌（HCC）患者中的抗病毒疗效的信息很少。因此，我们比较了这两种药物在这些患者中的抗病毒疗效。
我们回顾了 2005 年 1 月至 2009 年 9 月期间治疗的 134 例接受抗病毒治疗的 HBV 相关晚期 HCC（改良的国际抗癌联盟[UICC]肿瘤、淋巴结和转移[TNM]分期 III-IV 期）患者的医疗记录。在 HCC 诊断后，分别有 87（64.9%）和 47（35.1%）例患者接受了 LAM 和 ETV 治疗。
患者的平均年龄为 53 岁（115 名男性，19 名女性）。65（48.5%）和 69（51.5%）例患者分别患有 TNM 分期 III 和 IV 期 HCC。在随访期间，包括病毒学、生化学和血清学反应以及抗病毒耐药性的出现在内的治疗结果在 LAM 和 ETV 组中相似（均 P>0.05）。多变量分析确定 Child-Pugh 分级、α-胎蛋白和 TNM 分期是总生存期的独立预测因素（均 P<0.05）。抗病毒药物类型（LAM 与 ETV）并未影响总生存期（LAM 组的中位生存期为 9.6 个月，ETV 组为 13.6 个月；P=0.493）。在任何患者中，HCC 治疗均未因乙型肝炎病毒复发而中断。
LAM 和 ETV 的抗病毒疗效相似，抗病毒药物类型不影响 HBV 相关晚期 HCC 患者的总生存期。因此，在韩国，LAM 比 ETV 便宜，可能足以控制这些患者的 HBV。
