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乙肝病毒脱氧核糖核酸(HBV-DNA)载量高的中期肝细胞癌患者可能从术后抗乙肝病毒治疗中获益。

Intermediate-stage hepatocellular carcinoma patients with a high HBV-DNA load may benefit from postoperative anti-hepatitis B virus therapy.

作者信息

Rui Shaozhen, Yan Jun, Zhang Hui, Wang Zhengfeng, Zhou Wence

机构信息

General Surgery Department 2, The First Hospital of Lanzhou University, Lanzhou, China.

出版信息

Medicine (Baltimore). 2017 Jul;96(30):e7608. doi: 10.1097/MD.0000000000007608.

Abstract

Liver resection may be beneficial in intermediate-stage hepatocellular carcinoma (HCC), though the benefit of postoperative anti-hepatitis B virus (HBV) therapy in these patients remains unclear. In this study, we sought to evaluate the efficacy of postoperative anti-HBV for intermediate-stage HCC patients who underwent radical liver resection.According to inclusion and exclusion criteria, this study enrolled 202 HCC patients who underwent liver resection and had a high HBV-DNA load. The patients were divided into 2 groups on the basis of postoperative anti-HBV therapy: group A included patients undergoing postoperative anti-HBV therapy, whereas group B patients did not receive any postoperative anti-HBV therapy. Factors including baseline demographics, tumor characteristics, overall long-term survival, tumor-free survival, and tumor recurrence rate were compared between the 2 groups. Moreover, univariate and multivariate analyses were used to identify risk factors of HCC recurrence.Baseline demographics and tumor characteristics were comparable between the groups. The 1-, 3-, and 5-year overall survival rates in group A were 91.3%, 80.9%, and 66.1%, respectively, values that were significantly increased compared with group B (91.7%, 60.7%, and 52.4%, respectively, P = .019). Group A patients also exhibited enhanced 1-, 3-, and 5-year tumor-free survival compared with group B patients (87.0%, 67.0%, and 62.6%, respectively, in group A; 82.1%, 50.0%, and 42.9% in group B, P = .002). In addition, the tumor recurrence rate in group B was significantly increased compared with group A (P < .01). Univariate and multivariate analyses indicated lack of postoperative anti-HBV therapy [hazard ratio (HR) = 0.882; 95% confidence interval (CI), 0.712-0.938; P = .042] to be a predictor of tumor recurrence.For intermediate-stage [Barcelona Clinic Liver Cancer (BCLC) stage B] HCC with a high HBV-DNA load, postoperative anti-HBV therapy after curative resection should be routine adjuvant therapy.

摘要

肝切除术对于中期肝细胞癌(HCC)可能有益,不过术后抗乙型肝炎病毒(HBV)治疗对这些患者的益处仍不明确。在本研究中,我们试图评估术后抗HBV治疗对接受根治性肝切除术的中期HCC患者的疗效。根据纳入和排除标准,本研究纳入了202例行肝切除术且HBV-DNA载量高的HCC患者。根据术后抗HBV治疗情况将患者分为两组:A组包括接受术后抗HBV治疗的患者,而B组患者未接受任何术后抗HBV治疗。比较两组之间包括基线人口统计学特征、肿瘤特征、总体长期生存率、无瘤生存率和肿瘤复发率等因素。此外,采用单因素和多因素分析来确定HCC复发的危险因素。两组之间基线人口统计学特征和肿瘤特征具有可比性。A组1年、3年和5年总生存率分别为91.3%、80.9%和66.1%,与B组(分别为91.7%、60.7%和52.4%,P = 0.019)相比显著升高。与B组患者相比,A组患者1年、3年和5年无瘤生存率也有所提高(A组分别为87.0%、67.0%和62.6%;B组分别为82.1%、50.0%和42.9%,P = 0.002)。此外,B组肿瘤复发率与A组相比显著升高(P < 0.01)。单因素和多因素分析表明,未进行术后抗HBV治疗[风险比(HR)= 0.882;95%置信区间(CI),0.712 - 0.938;P = 0.042]是肿瘤复发的一个预测因素。对于具有高HBV-DNA载量的中期[巴塞罗那临床肝癌(BCLC)B期]HCC,根治性切除术后的术后抗HBV治疗应作为常规辅助治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74d3/5627838/03fcc44adf1a/medi-96-e7608-g002.jpg

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