接受抗病毒治疗的低水平HBV-DNA肝细胞癌患者肝切除术后的早期和晚期复发
Early and late recurrence after hepatectomy in patients with low-level HBV-DNA hepatocellular carcinoma under antiviral therapy.
作者信息
Li Ziqiang, Tan Chengpeng, Liu Xiaohong, Feng Zhe, Li Kun
机构信息
Department of Hepatobiliary and Pancreatic Surgery, Hubei Provincial Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430061, China.
出版信息
Infect Agent Cancer. 2022 Nov 17;17(1):56. doi: 10.1186/s13027-022-00468-6.
BACKGROUND
Antiviral therapy has been shown to benefit long-term survival after curative hepatectomy in patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) with high levels of HBV-DNA, but the impact of antiviral therapy on patient recurrence in patients with low levels of HBV-DNA remains less clear.
METHODS
This was a retrospective cohort study analyzing 296 patients with HBV-associated HCC with HBV-DNA levels < 2000 IU/mL who underwent hepatectomy at Zhongnan Hospital of Wuhan University between March 2013 and December 2017, of whom 157 patients received antiviral therapy (antiviral group) and 139 patients did not receive antiviral therapy (non-antiviral group), propensity score matching was used for survival analysis of patients in both groups, and subgroup analysis of major risk factors was performed.
RESULTS
The baseline characteristics of the two groups were comparable. At a median follow-up of 54 months, the 1-, 3-, and 5-year overall survival rates after propensity score matching (PSM) were 94.9%, 80.8%, 66.5%, and 90.9%, 64.6%, 49.4% for the antiviral and non-antiviral groups, respectively, p = 0.009, and the corresponding 1-, 3-, and 5-year RFS for the two groups were 81.8%, 76.8%, 76.8%, and 67.7%, 55.6%, 55.6%, respectively. p = 0.001, and the overall survival and recurrence-free survival were significantly better in the antiviral group than in the non-antiviral group. Multi-factor COX regression analysis showed that prothrombin time ≥ 13 s, methemoglobin level ≥ 20 ng/ml, platelet count ≥ 100 × 10/L, tumor size > 5 cm, tumor multiplicity was associated with early recurrence, and antiviral treatment was an independent protective factor for early recurrence of HCC (HR, 0.431; 95% CI 0.274-0.679; p < 0.001), but not associated with a low risk of late relapse (HR, 0.822; 95% CI 0.526-1.284; p = 0.389), and the main risk factors for late relapse included AST levels > 40 IU/ml, ALP levels > 130 IU/L, and the presence of satellite nodules, and subgroup analysis showed that compared to HBeAg-positive patients, antiviral therapy could significantly prolonged the recurrence-free survival of HBeAg-negative patients.
CONCLUSION
Antiviral therapy reduces early tumor recurrence after hepatectomy in patients with low levels of HBV-DNA.
背景
抗病毒治疗已被证明对乙肝病毒（HBV）相关肝细胞癌（HCC）且HBV-DNA水平高的患者在根治性肝切除术后的长期生存有益，但抗病毒治疗对HBV-DNA水平低的患者复发的影响仍不太清楚。
方法
这是一项回顾性队列研究，分析了2013年3月至2017年12月在武汉大学中南医院接受肝切除术的296例HBV相关HCC且HBV-DNA水平<2000 IU/mL的患者，其中157例患者接受了抗病毒治疗（抗病毒组），139例患者未接受抗病毒治疗（非抗病毒组），采用倾向评分匹配法对两组患者进行生存分析，并对主要危险因素进行亚组分析。
结果
两组的基线特征具有可比性。在中位随访54个月时，倾向评分匹配（PSM）后抗病毒组和非抗病毒组的1年、3年和5年总生存率分别为94.9%、80.8%、66.5%和90.9%、64.6%、49.4%，p = 0.009，两组相应的1年、3年和5年无复发生存率分别为81.8%、76.8%、76.8%和67.7%、55.6%、55.6%，p = 0.001，抗病毒组的总生存和无复发生存明显优于非抗病毒组。多因素COX回归分析显示，凝血酶原时间≥13 s、高铁血红蛋白水平≥20 ng/ml、血小板计数≥100×10/L、肿瘤大小>5 cm、肿瘤多发与早期复发相关，抗病毒治疗是HCC早期复发的独立保护因素（HR，0.431；95%CI 0.274 - 0.679；p < 0.001），但与晚期复发低风险无关（HR，0.822；95%CI 0.526 - 1.284；p = 0.389），晚期复发的主要危险因素包括AST水平>40 IU/ml、ALP水平>130 IU/L和卫星结节的存在，亚组分析显示，与HBeAg阳性患者相比，抗病毒治疗可显著延长HBeAg阴性患者的无复发生存期。
结论
抗病毒治疗可降低HBV-DNA水平低的患者肝切除术后的早期肿瘤复发。
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