抗病毒治疗对接受肝动脉灌注化疗的肝细胞癌患者乙肝病毒再激活及生存的影响
Effects of Antiviral Therapy on HBV Reactivation and Survival in Hepatocellular Carcinoma Patients Undergoing Hepatic Artery Infusion Chemotherapy.
作者信息
Liu Shousheng, Lai Jinfa, Lyu Ning, Xie Qiankun, Cao Huijiao, Chen Dabiao, He Meng, Zhang Bei, Zhao Ming
机构信息
State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of the General Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
Front Oncol. 2021 Feb 1;10:582504. doi: 10.3389/fonc.2020.582504. eCollection 2020.
BACKGROUND
This study aimed to investigate the influence of hepatic artery infusion chemotherapy (HAIC) on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg) positive patients with primary hepatocellular carcinoma (HCC) as well as evaluate the role of antiviral prophylaxis in these patients.
METHODS
We enrolled 170 HBsAg-positive advanced HCC patients receiving HAIC using mFOLFOX regimen, of which 137 patients received antiviral prophylaxis. Risk factors for HBV reactivation were analyzed. The overall survival (OS) from the first application of HAIC were compared between antiviral and non-antiviral groups.
RESULTS
A total of 25 patients (14.7%) developed HBV reactivation after HAIC, of which 16 patients received antiviral treatment and nine patients did not. The incidence of HBV reactivation was 11.7% (16/137) in antiviral group and 27.3% (9/33) in non-antiviral group respectively. No antiviral prophylactic was the only significant risk factor for HBV reactivation (OR=12.35, 95% confidence interval (CI) 4.35-33.33, p<0.001). Patients in antiviral group received more cycles of HAIC compared with non-antiviral group (3.11 ± 1.69 vs 1.75 ± 1.18, p<0.05) at the time of HBV reactivated. Seven of the 25 HBV reactivation patients developed hepatitis. OS in antiviral group was significantly longer than that of non-antiviral group (median 16.46 vs 10.68 months; HR=0.57; 95% CI, 0.36-0.91; p<0.05).
CONCLUSIONS
HBV reactivation is more prone to occur in the HBsAg-positive HCC patients undergoing HAIC without antiviral prophylaxis. Regular monitoring of HBV DNA and antiviral prophylaxis are suggested to prevent HBV reactivation as well as prolong the OS of these patients.
NAME OF THE TRIAL REGISTER
HAIC Using Oxaliplatin Plus Fluorouracil/Leucovorin for Patients with Locally Advanced HCC.
CLINICAL TRIAL REGISTRATION
https://www.clinicaltrials.gov/, identifier NCT02436044.
背景
本研究旨在探讨肝动脉灌注化疗（HAIC）对乙型肝炎表面抗原（HBsAg）阳性的原发性肝细胞癌（HCC）患者乙肝病毒（HBV）再激活的影响，并评估抗病毒预防在这些患者中的作用。
方法
我们纳入了170例接受mFOLFOX方案HAIC治疗的HBsAg阳性晚期HCC患者，其中137例患者接受了抗病毒预防。分析HBV再激活的危险因素。比较抗病毒组和非抗病毒组自首次应用HAIC后的总生存期（OS）。
结果
共有25例患者（14.7%）在HAIC后发生HBV再激活，其中16例患者接受了抗病毒治疗，9例未接受。抗病毒组HBV再激活发生率为11.7%（16/137），非抗病毒组为27.3%（9/33）。未进行抗病毒预防是HBV再激活的唯一显著危险因素（OR=12.35，95%置信区间（CI）4.35 - 33.33，p<0.001）。在HBV再激活时，抗病毒组患者接受的HAIC周期数多于非抗病毒组（3.11±1.69 vs 1.75±1.18，p<0.05）。25例HBV再激活患者中有7例发生肝炎。抗病毒组的OS显著长于非抗病毒组（中位数16.46 vs 10.68个月；HR=0.57；95%CI，0.36 - 0.91；p<0.05）。
结论
在未进行抗病毒预防的接受HAIC治疗的HBsAg阳性HCC患者中，HBV再激活更容易发生。建议定期监测HBV DNA并进行抗病毒预防，以预防HBV再激活并延长这些患者的OS。
试验注册名称
使用奥沙利铂加氟尿嘧啶/亚叶酸钙治疗局部晚期HCC的HAIC。
临床试验注册
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