Liu Kai-Xuan, Hong Jian-Guo, Wu Rui, Dong Zhao-Ru, Yang Ya-Fei, Yan Yu-Chuan, Yang Chun-Cheng, Yan Lun-Jie, Yao Sheng-Yu, Li Hai-Chao, Zhi Xu-Ting, Li Tao
Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China.
Front Oncol. 2021 Feb 19;11:605648. doi: 10.3389/fonc.2021.605648. eCollection 2021.
The clinical benefit of adjuvant antiviral therapy after curative therapy for HCC in patients with high preoperative HBV-DNA loads has been studied widely but that in patients with low preoperative HBV-DNA loads remains controversial. The purpose of this study was to determine the effect of antiviral treatment prophylaxis on HBV reactivation, overall survival (OS), and postoperative liver function in patients with low preoperative HBV-DNA levels undergoing curative resection.
A meta-analysis was conducted by searching Web of Science, PubMed, Embase, and Cochrane Library until May 2020. We used REVMAN for data analysis and completed the study under the PRISMA guidelines.
Three randomized trials and seven cohort studies, comprising of 1,131 individuals, were included in the meta-analysis. Antiviral treatment significantly reduced the rate of HBV reactivation after curative treatment of HCC, with a pooled risk ratio of 0.12 (95% c.i. 0.07 to 0.21; P < 0.00001). The trials were consistently favorable for the antiviral group, with a pooled hazard ratio of 0.52 (95% c.i. 0.37 to 0.74; P = 0.0002) in respect of OS rate. However, by pooling the data from studies that reported ALT on the 30th day postoperatively, the result didn't reach statistical significance (mean difference -4.38, 95% c.i. -13.83 to 5.07; P = 0.36). The I² values of the heterogeneity test for the above three comparisons are zero.
Antiviral therapy during curative resection is effective in reducing HBV reactivation and improving OS rate in HCC patients with low viral load.
术前HBV - DNA高载量的肝癌患者在根治性治疗后辅助抗病毒治疗的临床益处已得到广泛研究，但术前HBV - DNA低载量患者的情况仍存在争议。本研究旨在确定抗病毒预防性治疗对术前HBV - DNA水平低且接受根治性切除的患者HBV再激活、总生存期（OS）和术后肝功能的影响。
通过检索Web of Science、PubMed、Embase和Cochrane图书馆直至2020年5月进行荟萃分析。我们使用REVMAN进行数据分析，并按照PRISMA指南完成研究。
荟萃分析纳入了3项随机试验和7项队列研究，共1131例个体。抗病毒治疗显著降低了肝癌根治性治疗后HBV再激活率，合并风险比为0.12（95%置信区间0.07至0.21；P < 0.00001）。试验结果一直有利于抗病毒治疗组，就OS率而言，合并风险比为0.52（95%置信区间0.37至0.74；P = 0.0002）。然而，通过汇总术后第30天报告ALT的研究数据，结果未达到统计学显著性（平均差异 -4.38，95%置信区间 -13.83至5.07；P = 0.36）。上述三项比较的异质性检验I²值均为零。
根治性切除术中的抗病毒治疗可有效降低低病毒载量肝癌患者的HBV再激活并提高OS率。
