Li Xing, Zhong Xiang, Chen Zhan-Hong, Wang Tian-Tian, Ma Xiao-Kun, Xing Yan-Fang, Wu Dong-Hao, Dong Min, Chen Jie, Ruan Dan-Yun, Lin Ze-Xiao, Wen Jing-Yun, Wei Li, Wu Xiang-Yuan, Lin Qu
Department of Medical Oncology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China E-mail :
Asian Pac J Cancer Prev. 2015;16(18):8665-70. doi: 10.7314/apjcp.2015.16.18.8665.
Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE.
A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints.
Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation.
Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.
据报道，经动脉化疗栓塞术（TACE）可诱发乙肝病毒（HBV）再激活，在HBV相关肝细胞癌（HCC）患者中发生率较高。在这一特定患者群体中，降低因HBV再激活导致肝炎发作的有效策略仅限于拉米夫定。本回顾性研究旨在探讨预防性使用恩替卡韦对接受TACE的HCC患者的疗效。
分析了连续191例接受TACE的HBV相关HCC患者，其中44例接受了预防性恩替卡韦治疗。病毒学事件定义为血清HBV DNA水平升高至比最低点水平高1 log10拷贝/ml以上，因HBV再激活导致的肝炎发作是主要终点。
接受或未接受预防性治疗的患者在宿主因素以及与肿瘤因素、HBV状态、肝功能和淋巴细胞/单核细胞比值相关的大多数特征方面相似。值得注意的是，两组之间TACE的周期相似。10例（22.7%）接受预防性恩替卡韦治疗的患者达到病毒学应答。与未接受预防性治疗的患者相比，接受预防性恩替卡韦治疗的患者病毒学事件显著减少（6.8%对54.4%，p = 0.000），因HBV再激活导致的肝炎发作也显著减少（0.0%对11.6%，p = 0.039）。Kaplan-Meier分析表明，恩替卡韦组患者的无病毒学事件生存期（p = 0.000）和无肝炎发作生存期（p = 0.017）显著改善。女性和东部肿瘤协作组（ECOG）体能状态为2是未接受预防性抗病毒治疗患者病毒学事件的唯一显著预测因素。挽救性抗病毒治疗并未降低因HBV再激活导致的肝炎发作发生率。
预防性使用恩替卡韦在接受TACE的HBV相关癌症患者中显示出有前景的疗效。较低的体能状态和女性性别可能是这些患者HBV再激活的预测因素。
