Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Aliment Pharmacol Ther. 2017 May;45(9):1213-1224. doi: 10.1111/apt.14015. Epub 2017 Feb 27.
Patients with chronic hepatitis B (CHB) need long-term antiviral treatment with nucleos(t)ide analogues (NA). Animal studies suggest that some NA may increase cancer risk, but human data are lacking.
To investigate cancer risks in patients with or without NA treatment.
We conducted a territory-wide cohort study using the database from Hospital Authority in Hong Kong. The diagnosis of CHB and various malignancies was based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes between 2000 and 2012. Patients exposed to any of the oral NA for CHB were included. The primary outcome was incident cancers. A 3-year landmark analysis, with follow-up up to 7 years, was used to evaluate the relative risk of cancers in treated and untreated patients.
A total of 44 494 patients (39 712 untreated and 4782 treated) were included in the analysis. During 194 890 patient-years of follow-up, hepatocellular carcinoma developed in 402 (1.0%) untreated patients and 179 (3.7%) treated patients, while other cancers developed in 528 (1.3%) and 128 (2.7%) patients respectively. After propensity score weighting, treated patients had similar risks of all malignancies [weighted hazard ratio (wHR): 1.01, 95% CI: 0.82-1.25, P = 0.899], lung/pleural cancers (wHR: 0.82, 95% CI: 0.52-1.31, P = 0.409) and urinary/renal malignancies (wHR: 1.04, 95% CI: 0.38-2.81, P = 0.944) when compared with untreated patients.
Oral nucleos(t)ide analogue treatment does not appear to increase cancer risk in patients with chronic hepatitis B. Given the beneficial effect on liver outcomes, our data support the current practice of long-term anti-viral therapy.
慢性乙型肝炎（CHB）患者需要长期接受核苷（酸）类似物（NA）抗病毒治疗。动物研究表明，某些 NA 可能会增加癌症风险，但缺乏人类数据。
研究有或无 NA 治疗的患者的癌症风险。
我们使用香港医院管理局的数据库进行了一项全港范围的队列研究。CHB 和各种恶性肿瘤的诊断依据的是 2000 年至 2012 年期间的国际疾病分类，第九修订版，临床修正（ICD-9-CM）诊断代码。纳入接受任何口服 NA 治疗 CHB 的患者。主要结局是新发癌症。使用 3 年时间标记分析，随访时间最长为 7 年，评估治疗和未治疗患者的癌症相对风险。
共纳入 44494 例患者（39712 例未治疗和 4782 例治疗）进行分析。在 194890 患者年的随访期间，未治疗患者中有 402 例（1.0%）发生肝细胞癌，治疗患者中有 179 例（3.7%）发生，而其他癌症分别在 528 例（1.3%）和 128 例（2.7%）患者中发生。经过倾向评分加权后，治疗患者的所有恶性肿瘤（加权风险比（wHR）：1.01，95%置信区间：0.82-1.25，P=0.899）、肺部/胸膜癌症（wHR：0.82，95%置信区间：0.52-1.31，P=0.409）和泌尿系统/肾脏恶性肿瘤（wHR：1.04，95%置信区间：0.38-2.81，P=0.944）的风险与未治疗患者相似。
口服核苷（酸）类似物治疗似乎不会增加慢性乙型肝炎患者的癌症风险。鉴于对肝脏结局的有益影响，我们的数据支持目前长期抗病毒治疗的实践。
