Rui Shaozhen, Yan Jun, Zhang Hui, Wang Zhengfeng, Zhou Wence
General Surgery Department 2, The First Hospital of Lanzhou University, Lanzhou, China.
Medicine (Baltimore). 2017 Jul;96(30):e7608. doi: 10.1097/MD.0000000000007608.
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.
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。