Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2021 Oct;37(10):894-902. doi: 10.1002/kjm2.12413. Epub 2021 Jun 24.
Sorafenib is the recommended first-line treatment option for patients with advanced hepatocellular carcinoma (HCC). Hepatitis C virus (HCV)-related advanced HCC (HCV-HCC) seemed to have a better response than hepatitis B virus (HBV)-related HCC (HBV-HCC) in sorafenib use, but it was undetermined. Hence, we aimed to investigate the effect of sorafenib between HBV-HCC and HCV-HCC patients in Taiwan. From August 2012 to December 2016, 575 consecutive advanced HCC patients received sorafenib under the reimbursement of Taiwan national health insurance in our hospital. Radiologic assessment was performed at a 2-month interval. Those patients with tumor progression or liver function deterioration were disallowed for further sorafenib use. Patients with HBV or HCV infection were, retrospectively, enrolled and followed till December 2018. There were 277 (62.4%) HBV-HCC patients and 167 (37.6%) HCV-HCC patients. Before sorafenib, 192 (69.3%) HBV-HCC patients who had used nucleoside analogs (NAs) for HBV management, whereas only 5 (3%) HCV-HCC patients received interferon-based antiviral therapy. Overall survival (OS) of HCV-HCC patients was significantly superior to HBV-HCC patients without NAs (8.8 months vs. 4.9 months, p = 0.006), but was noninferior to HBV-HCC patients with NAs (8.8 months vs. 10.7 months, p = 0.54). Using propensity score matching, progression-free survival (2.0 months vs. 2.1 months, p = 0.374) and OS (10.5 months vs. 9.6 months, p = 0.746) between HBV-HCC and HCV-HCC groups were not different. Antiviral therapy might increase survival benefits of advanced HBV-HCC patients underwent sorafenib use, leading to a comparable OS to HCV-HCC patients in Taiwan.
索拉非尼是晚期肝细胞癌（HCC）患者的首选一线治疗方案。在使用索拉非尼时，丙型肝炎病毒（HCV）相关的晚期 HCC（HCV-HCC）似乎比乙型肝炎病毒（HBV）相关 HCC（HBV-HCC）的反应更好，但尚未确定。因此，我们旨在研究台湾地区 HBV-HCC 和 HCV-HCC 患者使用索拉非尼的效果。
从 2012 年 8 月至 2016 年 12 月，575 例连续接受索拉非尼治疗的晚期 HCC 患者在我院接受了国家健康保险报销。每 2 个月进行一次影像学评估。那些肿瘤进展或肝功能恶化的患者不允许进一步使用索拉非尼。回顾性地招募了 HBV 或 HCV 感染的患者，并随访至 2018 年 12 月。
其中有 277 例（62.4%）HBV-HCC 患者和 167 例（37.6%）HCV-HCC 患者。在使用索拉非尼之前，192 例（69.3%）HBV-HCC 患者曾使用核苷类似物（NAs）治疗 HBV，而仅有 5 例（3%）HCV-HCC 患者接受了基于干扰素的抗病毒治疗。
HCV-HCC 患者的总生存期（OS）明显优于未使用 NAs 的 HBV-HCC 患者（8.8 个月 vs. 4.9 个月，p=0.006），但与使用 NAs 的 HBV-HCC 患者无差异（8.8 个月 vs. 10.7 个月，p=0.54）。
通过倾向评分匹配，HBV-HCC 组和 HCV-HCC 组的无进展生存期（2.0 个月 vs. 2.1 个月，p=0.374）和 OS（10.5 个月 vs. 9.6 个月，p=0.746）无差异。
抗病毒治疗可能会增加接受索拉非尼治疗的晚期 HBV-HCC 患者的生存获益，使他们的 OS 与台湾地区 HCV-HCC 患者相当。
