及时消除 HCV 病毒血症对于预防 CHC-HCC 患者 RFA 后复发至关重要。
Timely eradication of HCV viremia by PegIFN/RBV is crucial in prevention of post RFA recurrence in CHC-HCC patients.
机构信息
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taiwan; College of Medicine, Chang Gung University, Taiwan.
出版信息
J Formos Med Assoc. 2019 Aug;118(8):1239-1246. doi: 10.1016/j.jfma.2018.11.014. Epub 2018 Dec 21.
BACKGROUND
Secondary prevention of hepatocellular carcinoma (HCC) among patients with chronic hepatitis C (CHC) who achieve sustained virologic response (SVR) with interferon-based therapy has been proved effective. However, tertiary prevention with PegIFN/RBV therapy of HCC recurrence seems limited effect in CHC-HCC patients post curative therapies. This study aims to investigate the timing and impact of PegIFN/RBV treatment on prevention of HCC recurrence in patients after RFA treatment.
METHODS
From 2013 to 2016, a total of 137 CHC-HCC patients from a 508 patient based cohort receiving complete RFA treatment in Chang Gung Memorial Hospital, Linkou Medical Center were retrospectively recruited. Pre-RFA patient demographics were analyzed by cox regression analysis for prediction on tumor recurrence. Statistics analysis was performed with SPSS V.20 (IBM, USA).
RESULTS
The mean age of the 137 patients were 69.6 year-old and 71.5% of patients were cirrhotic. After propensity score matching, one hundred and two patients were enrolled into the analysis. Fifty-one patients (50%) received PegIFN/RBV therapy and twenty-seven patients (52.9%) achieved SVR. Patients who could achieve SVR had lower tumor recurrence rate than non-SVR and untreated groups (29.6% vs. 66.7% vs. 49.0%, P = 0.030). The effect is more prominent in those achieve SVR prior to compared with after RFA despite not reach statistically significant (26.1% vs. 50.0%, P = 0.334).
CONCLUSION
Timely treatment with SVR achievement has the lowest tumor recurrence rate in CHC-HCC patients. Secondary prevention might be even more important than tertiary prevention in CHC patients, especially regarding prevention of post RFA HCC recurrence.
背景
对于接受基于干扰素的治疗实现持续病毒学应答（SVR）的慢性丙型肝炎（CHC）患者，已经证明其肝细胞癌（HCC）的二级预防是有效的。然而，在根治性治疗后的 CHC-HCC 患者中，用 PegIFN/RBV 治疗 HCC 复发的三级预防效果似乎有限。本研究旨在探讨 PegIFN/RBV 治疗预防 RFA 治疗后 HCC 复发的时机和效果。
方法
从 2013 年至 2016 年，我们回顾性地从在长庚纪念医院林口医疗中心接受完整 RFA 治疗的 508 例患者中招募了 137 例 CHC-HCC 患者。通过 Cox 回归分析预测肿瘤复发，对 RFA 前患者的人口统计学特征进行分析。采用 SPSS V.20（IBM，美国）进行统计分析。
结果
137 例患者的平均年龄为 69.6 岁，71.5%的患者患有肝硬化。在进行倾向评分匹配后，102 例患者纳入分析。51 例（50%）患者接受 PegIFN/RBV 治疗，27 例（52.9%）患者达到 SVR。达到 SVR 的患者肿瘤复发率低于非 SVR 组和未治疗组（29.6%比 66.7%比 49.0%，P=0.030）。尽管未达到统计学意义，但与 RFA 后相比，在 RFA 前达到 SVR 的患者效果更为显著（26.1%比 50.0%，P=0.334）。
结论
及时达到 SVR 的治疗可使 CHC-HCC 患者的肿瘤复发率最低。二级预防对于 CHC 患者可能比三级预防更为重要，尤其是在预防 RFA 后 HCC 复发方面。
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