CRC "A.M. e A. Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
Aliment Pharmacol Ther. 2018 Aug;48(4):431-439. doi: 10.1111/apt.14848. Epub 2018 Jun 19.
Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development.
To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients.
All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied.
Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second-line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%.
HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.
长期口服核苷（酸）类似物（NUC）治疗乙型肝炎病毒（HBV）相关代偿性肝硬化可预防临床失代偿，但不能预防肝细胞癌（HCC）的发生。
明确长期 NUC 治疗的 HBV 患者 HCC 的临床特征和结局。
研究了 2005 年至 2016 年间在接受监测的 NUC 治疗的 HBV 患者中发生的 HCC，排除了在治疗的前 6 个月内发生的 HCC。研究了 HCC 的临床特征、甲胎蛋白（AFP）模式和患者的结局。
共纳入 76 例 HCC 患者。中位年龄为 67（40-83）岁，84%为男性，96%为白种人，95%HBeAg 阴性，96%HBV DNA 不可检测，83%ALT 水平正常，92%为代偿性肝硬化。中位血清 AFP 水平为 4（1-3615）ng/ml（>7ng/ml 占 36%）。HCC 单发占 78%，直径中位数为 20（6-57）mm，92%处于早期阶段，78%（39%消融、28%手术切除、11%肝移植）可获得潜在治愈性治疗。总的来说，61 例（80%）患者获得完全缓解：40 例接受一线治疗后缓解，3 例二线治疗后缓解，2 例三线治疗后缓解，16 例接受肝移植（8 例二线）。在 HCC 诊断后 45（7-144）个月时，19 例患者死亡，84%死于 HCC 进展。中位复发时间为 20.2（3-53）个月，累积 5 年肝脏相关生存率为 74%。
长期 NUC 治疗患者发生的 HCC 为单发、小肿瘤，可采用治愈性治疗，可获得极佳的 5 年生存率。
