Wei Yanyan, Yi Yongxiang, Tao Chen, Ye Wei, Zhao Wei
Department of Infectious Diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China.
Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Cancer Manag Res. 2019 Sep 17;11:8475-8486. doi: 10.2147/CMAR.S201744. eCollection 2019.
Hepatocellular carcinoma (HCC) is the second leading causes of cancer-related death. HCC is usually based on chronic liver disease, mainly including chronic hepatitis C virus infection or chronic hepatitis B virus (HBV) infection.
The objective of the study was to evaluate the impact of the nucleos(t)ide analog (NA) use on the prognosis of patients with HBV-related small hepatocellular carcinomas (HBV-SHCC).
In this retrospective study, there were 134 patients who had been treated with long-term NA before SHCC diagnosis as NA-experienced group, 43 patients received NA-naïve treatment after SHCC diagnosis as NA-naïve group, and 15 patients who did not receive NA treatment as untreated group. Among these patients, some patients underwent surgical resection and others with local recurrence were treated with transarterial chemoembolization (TACE), TACE-percutaneous microwave coagulation therapy or TACE alone. The Kaplan-Meier and Cox-proportional hazard model were used to calculate the survival analysis.
The data showed that 1-year, 3-year, 5-year overall survival rate of HBV-SHCC patients in NA-experienced group were 90.27%, 90.69%, 65%, NA-naïve group were 70.81%, 73.95%, 47.39%, and untreated group were 54.96%, 40.44%, 47.39%, respectively (Log-rank, =0.031). The median survival time of HBV-SHCC patients treated with adefovir dipivoxil (ADV) or LAM+ADV has the longest survival time. Patients who have received rescue treatment after viral breakthrough or gotten maintained viral response had longer survival times than those who have not received rescue treatment after viral breakthrough or non-response. Compared with timely rescue treatment, viral breakthrough (hazard ratio=3.624, 95% CI, 1.035-12.687, =0.044) was an independent risk factor for HBV-SHCC patients with Cox-proportional hazard model. For these patients conforming to NA-treatment indications, commencement of NA treatment should be given even after HBV-SHCC diagnosis. Moreover, HBV-SHCC patients who were suffering from virus break through should be treated timely rescue therapy even if their liver function was normal.
SHCC patients treated with low drug resistance barrier drugs may not change the treatment regimen if they have gotten virological response.
肝细胞癌（HCC）是癌症相关死亡的第二大主要原因。HCC通常基于慢性肝病，主要包括慢性丙型肝炎病毒感染或慢性乙型肝炎病毒（HBV）感染。
本研究的目的是评估核苷（酸）类似物（NA）的使用对HBV相关小肝细胞癌（HBV-SHCC）患者预后的影响。
在这项回顾性研究中，有134例患者在SHCC诊断前接受了长期NA治疗作为NA经验组，43例患者在SHCC诊断后接受了初治NA治疗作为初治组，15例患者未接受NA治疗作为未治疗组。在这些患者中，一些患者接受了手术切除，其他局部复发的患者接受了经动脉化疗栓塞（TACE）、TACE-经皮微波凝固治疗或单独的TACE治疗。采用Kaplan-Meier法和Cox比例风险模型进行生存分析。
数据显示，NA经验组HBV-SHCC患者的1年、3年、5年总生存率分别为90.27%、90.69%、65%，初治组分别为70.81%、73.95%、47.39%，未治疗组分别为54.96%、40.44%、47.39%（Log-rank，=0.031）。接受阿德福韦酯（ADV）或拉米夫定+ADV治疗的HBV-SHCC患者的中位生存时间最长。病毒突破后接受挽救治疗或获得持续病毒学应答者比未接受病毒突破后挽救治疗或无应答者的生存时间更长。与及时挽救治疗相比，病毒突破（风险比=3.624，95%CI，1.035-12.687，=0.044）是Cox比例风险模型中HBV-SHCC患者的独立危险因素。对于符合NA治疗指征的这些患者，即使在HBV-SHCC诊断后也应开始NA治疗。此外，即使肝功能正常，发生病毒突破的HBV-SHCC患者也应及时接受挽救治疗。
使用低耐药性屏障药物治疗的SHCC患者如果获得了病毒学应答，可能无需改变治疗方案。
