Xu Z, Dai W, Wu Y-T, Arshad B, Li X, Wu H, Chen H-R, Wu K-N, Kong L-Q
Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Eur J Cancer Care (Engl). 2018 Mar;27(2):e12799. doi: 10.1111/ecc.12799. Epub 2017 Dec 19.
Hepatitis B virus (HBV) reactivation is a remarkable risk during the chemotherapy for solid tumour patients. Nucleos(t)ide analogues (NAs) are recommended as prophylaxis for the reactivation of HBV infection in some cancer patients prior to systemic chemotherapy. Therefore, we performed a meta-analysis aiming to determine the efficacy of prophylactic lamivudine on prevention of HBV reactivation and its related negative outcomes among solid tumour patients with chronic HBV infection receiving systemic chemotherapy. The primary outcome was HBV reactivation, and the secondary outcomes were HBV-related hepatitis, chemotherapy disruption, mortality and tyrosine-methio-nine-aspartate-aspartate (YMDD) mutations. Twelve original researches involving 1,101 patients were analysed in this study. The relative risk of HBV reactivation in patients with lamivudine prophylaxis was significantly lower than that without prophylaxis (RR = 0.17, 95% CL: 0.10-0.29, p < .00001). Lamivudine prophylaxis reduced the relative risk of hepatitis (p < .00001), chemotherapy disruptions (p = .01) and mortality (p = .08) due to HBV reactivation. Lamivudine prophylaxis is effective in reducing HBV reactivation and its related negative outcomes, such as hepatitis and chemotherapy disruption and mortality among chemotherapeutic solid tumour patients with chronic HBV infection. Future studies should lay more emphasis on the early HBV screening, mode of treatment and duration of NAs prophylaxis among solid tumour patients receiving chemotherapy.
乙型肝炎病毒（HBV）再激活是实体瘤患者化疗期间的一个显著风险。核苷（酸）类似物（NAs）被推荐用于一些癌症患者在全身化疗前预防HBV感染再激活。因此，我们进行了一项荟萃分析，旨在确定拉米夫定预防慢性HBV感染的实体瘤患者接受全身化疗时HBV再激活及其相关不良后果的疗效。主要结局是HBV再激活，次要结局是HBV相关肝炎、化疗中断、死亡率和酪氨酸-甲硫氨酸-天冬氨酸-天冬氨酸（YMDD）突变。本研究分析了12项涉及1101例患者的原始研究。接受拉米夫定预防的患者中HBV再激活的相对风险显著低于未接受预防的患者（RR = 0.17，95%CI：0.10 - 0.29，p <.00001）。拉米夫定预防降低了因HBV再激活导致的肝炎（p <.00001）、化疗中断（p =.01）和死亡率（p =.08）的相对风险。拉米夫定预防在降低慢性HBV感染的化疗实体瘤患者中HBV再激活及其相关不良后果（如肝炎、化疗中断和死亡率）方面是有效的。未来的研究应更加强调接受化疗的实体瘤患者的早期HBV筛查、治疗方式和NAs预防持续时间。
