Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
Korean Liver Cancer Association, Seoul, Republic of Korea.
J Gastroenterol Hepatol. 2018 Feb;33(2):475-483. doi: 10.1111/jgh.13848.
Over the past decade, the management of hepatocellular carcinoma (HCC) and viral hepatitis has been improved. We explored survival trends and factors affecting survival of HCC in a hepatitis B virus (HBV)-endemic population.
From 31 521 and 38 167 HCC registrants to the population-based national cancer registry in Korea, an HBV-endemic country, in the period of 2003-2005 and 2008-2010, we randomly sampled cohorts of 4515 and 4582 patients, respectively, for the investigation of clinical characteristics and survival.
Compared with Cohort 2003-2005, Cohort 2008-2010 had significantly better liver function (Child-Turcotte-Pugh class A, 64.2% vs 71.6%; P < 0.001) and had more advanced tumor stages (Barcelona Clinic Liver Cancer stage B-D, 45.8% vs 50.4%; P < 0.001). HBV was the predominant cause of HCC in both cohorts (62.5% vs 62.2%; P = 0.70). Cohort 2008-2010 had significantly better overall survival than Cohort 2003-2005 by age-adjusted univariate, multivariable, and propensity score-matched analyses (median survival time, 17.2 vs 28.4 months; P < 0.001). In a subcohort analysis, a consistently significant inter-cohort improvement in survival was observed only in patients with HBV-related HCC (median survival, 16.1 vs 30.4 months; P < 0.001). The annual number of patients with HCC receiving oral antiviral agents for HBV precipitously increased from 93 in 2005 to 28 520 in 2010 in the country.
The consistent improvement in survival of patients with HCC was confined to HBV-related HCC subcohort over the last decade in an HBV-endemic population. The survival improvement coincided with the exponential use of oral antiviral agents for HBV in the patients.
在过去十年中，肝细胞癌（HCC）和病毒性肝炎的治疗管理得到了改善。我们在乙型肝炎病毒（HBV）流行的国家韩国的人群中探讨了 HCC 患者的生存趋势和影响生存的因素。
从韩国的人群癌症登记处（HBV 流行地区）2003-2005 年和 2008-2010 年登记的 31521 例和 38167 例 HCC 患者中，我们分别随机抽取了 4515 例和 4582 例患者的队列，以调查临床特征和生存情况。
与 2003-2005 年队列相比，2008-2010 年队列的肝功能（Child-Turcotte-Pugh 分级 A，64.2%比 71.6%；P<0.001）显著改善，肿瘤分期也更晚期（巴塞罗那临床肝癌分期 B-D，45.8%比 50.4%；P<0.001）。两个队列中 HBV 都是 HCC 的主要病因（62.5%比 62.2%；P=0.70）。经年龄调整的单因素、多因素和倾向评分匹配分析，2008-2010 年队列的总生存时间明显优于 2003-2005 年队列（中位生存时间，17.2 比 28.4 个月；P<0.001）。在亚组分析中，只有在 HBV 相关 HCC 患者中，两个队列之间的生存改善才具有统计学意义（中位生存时间，16.1 比 30.4 个月；P<0.001）。该国 2005 年接受乙型肝炎病毒口服抗病毒药物治疗的 HCC 患者每年为 93 例，到 2010 年急剧增加到 28520 例。
在过去十年中，HBV 流行地区的 HCC 患者的生存改善一直局限于 HBV 相关 HCC 亚组。生存的改善与乙型肝炎病毒患者中口服抗病毒药物的指数级应用相吻合。
