一线吉西他滨联合顺铂治疗肝内胆管癌时乙肝病毒感染的预后意义

Prognostic implications of hepatitis B virus infection in intrahepatic cholangiocarcinoma treated with first-line gemcitabine plus cisplatin.

作者信息

Chae Heejung, Cho Hyungwoo, Yoo Changhoon, Kim Kyu-Pyo, Jeong Jae Ho, Chang Heung-Moon, Kang Jihoon, Lee Han Chu, Lim Young-Suk, Kim Kang Mo, Shim Ju Hyun, Lee Sang Soo, Park Do Hyun, Song Tae Jun, Hwang Shin, Song Gi-Won, Moon Deok-Bog, Lee Young-Joo, Lee Jae Hoon, Ryoo Baek-Yeol

机构信息

1 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

2 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

Int J Biol Markers. 2018 Nov;33(4):432-438. doi: 10.1177/1724600818777239. Epub 2018 Jun 6.

DOI:10.1177/1724600818777239

PMID:29874985

Abstract

PURPOSE

: Hepatitis B virus infection is a well-known risk factor for intrahepatic cholangiocarcinoma. However, its prognostic impact has rarely been investigated in advanced intrahepatic cholangiocarcinoma.

METHODS

: Between April 2010 and May 2015, 296 patients with unresectable or metastatic intrahepatic cholangiocarcinoma who received gemcitabine plus cisplatin (GemCis) were categorized into a hepatitis B virus group (n=62; 21%) and a non-hepatitis B virus group (n=234; 79%). Clinicopathological features and survival outcomes were retrospectively reviewed and analyzed.

RESULTS

: The median age of patients was 59 years (range, 27-78). The median overall survival with first-line GemCis was 9.4 months (95% CI 8.4, 10.4). Compared to the non-hepatitis B virus group, the hepatitis B virus group was younger (median age, 57 vs. 61 years, P = 0.001), mainly male (74% vs. 57%, P = 0.02), and had lower frequency of elevated cancer antigen (CA) 19-9 (34% vs. 59%, P = 0.001) and alkaline phosphatase (43% vs. 61%, P = 0.01). In a univariate analysis, the hepatitis B virus infection showed a marginal relationship with poor overall survival compared to the non-hepatitis B virus infection (median, 8.3 vs. 10.0 months; P=0.13). A multivariate analysis of potential prognostic factors revealed a significant association with poor overall survival in the hepatitis B virus group (hazard ratio (HR) =1.50, P = 0.02). Initial metastatic disease (vs. recurrent/unresectable disease; HR=1.50), metastatic sites ⩾ 2 (vs. 0-1; HR=1.51), Eastern Cooperative Oncology Group performance status ⩾ 2 (vs. 0-1; HR=1.93), elevated total bilirubin (vs. normal; HR=1.83), and low albumin (vs. normal; HR=1.52) were significantly related to an unfavorable overall survival.

CONCLUSIONS

: This study suggests that the hepatitis B virus infection may be associated with distinctive clinicopathological characteristics and poor outcome in advanced intrahepatic cholangiocarcinoma treated with GemCis.

摘要

目的

乙型肝炎病毒感染是肝内胆管癌的一个众所周知的危险因素。然而，其对晚期肝内胆管癌预后的影响鲜有研究。

方法

在2010年4月至2015年5月期间，296例接受吉西他滨联合顺铂（GemCis）治疗的不可切除或转移性肝内胆管癌患者被分为乙型肝炎病毒组（n = 62；21%）和非乙型肝炎病毒组（n = 234；79%）。对临床病理特征和生存结果进行回顾性分析。

结果

患者的中位年龄为59岁（范围27 - 78岁）。一线GemCis治疗后的中位总生存期为9.4个月（95%CI 8.4，10.4）。与非乙型肝炎病毒组相比，乙型肝炎病毒组患者更年轻（中位年龄57岁对61岁，P = 0.001），主要为男性（74%对57%，P = 0.02），癌抗原（CA）19 - 9升高（34%对59%，P = 0.001）和碱性磷酸酶升高（43%对61%，P = 0.01）的频率更低。在单因素分析中，与非乙型肝炎病毒感染相比，乙型肝炎病毒感染与较差的总生存期呈边缘性相关（中位生存期8.3个月对10.0个月；P = 0.13）。对潜在预后因素的多因素分析显示，乙型肝炎病毒组与较差的总生存期显著相关（风险比（HR）= 1.50，P = 0.02）。初始转移性疾病（与复发/不可切除疾病相比；HR = 1.50）、转移部位≥2个（与0 - 1个相比；HR = 1.51）、东部肿瘤协作组体能状态≥2（与0 - 1相比；HR = 1.93）、总胆红素升高（与正常相比；HR = 1.83）和低白蛋白（与正常相比；HR = 1.52）与不良的总生存期显著相关。