Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan Province, China.
Centre of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
J Gastrointest Surg. 2021 Jun;25(6):1419-1429. doi: 10.1007/s11605-020-04633-3. Epub 2020 May 14.
Postoperative oral antiviral treatment with nucleoside or nucleotide analogues can suppress viral replication and reduce tumour recurrence for patients with hepatitis b virus-related hepatocellular carcinoma (HBV-related HCC) after curative resection. However, the superior antiviral treatment is still unclear. We conducted this study to investigate the different effects of nucleotide and nucleoside analogues on the prognosis of HBV-related HCC after curative resection.
From February 2007 to February 2016, 487 consecutive patients with newly diagnosed HCC according to the Milan criteria who underwent R0 resection were enrolled according to the inclusion and exclusion criteria. According to their postoperative antiviral treatment, they were divided into the nucleotide group (NtA, n = 111) and the nucleoside group (NsA, n = 376).
The baseline characteristics, serologic parameters, tumour characteristics, and operative data of the 2 groups were comparable. Nucleotide analogue use significantly decreased HCC recurrence (P = 0.028) and HCC-related death (P = 0.004), with hazard ratios (HRs) of 0.685 (95% CI, 0.484 to 0.971, P = 0.033) and 0.507 (95% CI, 0.310 to 0.830, P = 0.004), respectively, in multivariate Cox analyses. After the study patients were stratified according to three variables, we found that nucleotide analogue use was significantly associated with increased disease-free and overall survival among patients with cirrhosis, HBeAg-negative patients, and patients with positive HBV-DNA.
In patients with HBV-related HCC, nucleotide analogues but not nucleoside analogues significantly reduced HCC recurrence and improved overall survival after R0 hepatic resection.
核苷（酸）类似物的术后口服抗病毒治疗可以抑制乙型肝炎病毒相关肝细胞癌（HBV-HCC）患者的病毒复制并降低肿瘤复发率。然而，哪种抗病毒治疗更具优势仍不明确。本研究旨在探讨核苷酸类似物和核苷类似物对根治性切除术后 HBV-HCC 患者预后的不同影响。
2007 年 2 月至 2016 年 2 月，根据米兰标准，纳入 487 例符合条件的行根治性切除术后的 HCC 患者。根据术后抗病毒治疗将患者分为核苷酸组（NtA，n=111）和核苷组（NsA，n=376）。
两组患者的基线特征、血清学参数、肿瘤特征和手术数据均无差异。核苷酸类似物的使用显著降低了 HCC 复发率（P=0.028）和 HCC 相关死亡率（P=0.004），多因素 Cox 分析的风险比（HR）分别为 0.685（95%可信区间，0.4840.971，P=0.033）和 0.507（95%可信区间，0.3100.830，P=0.004）。在根据三个变量对研究患者进行分层后，我们发现核苷酸类似物的使用与肝硬化、HBeAg 阴性和 HBV-DNA 阳性患者的无病生存率和总生存率的提高显著相关。
在 HBV-HCC 患者中，核苷酸类似物而非核苷类似物可显著降低 R0 肝切除术后 HCC 的复发率并改善总体生存率。
