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标题: 口服抗病毒治疗患者肝癌的风险较高相比非活动期患者 [打印本页]

作者: StephenW 时间: 2014-11-1 17:26 标题: 口服抗病毒治疗患者肝癌的风险较高相比非活动期患者

本帖最后由 StephenW 于 2014-11-1 17:28 编辑

Gut 2014;63:1943-1950 doi:10.1136/gutjnl-2013-306409

Hepatology

Original article

Patients with chronic hepatitis B treated with oral antiviral therapy retain a higher risk for HCC compared with patients with inactive stage disease

+ Author Affiliations

1Division of Gastroenterology and Hepatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Division of Gastroenterology and Hepatology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Chang Won, Korea

Correspondence to Professor Yong-Han Paik, Division of Gastroenterology and Hepatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea; [email protected]

Received 9 November 2013
Revised 2 February 2014
Accepted 3 February 2014
Published Online First 10 March 2014

Abstract

Background It is generally stated that oral antiviral therapy in patients with chronic hepatitis B (CHB) decreases the risk of developing hepatocellular carcinoma (HCC). Although oral nucleos(t)ide analogues (NUCs) may induce a state similar to inactive stage CHB, the long-term risk for HCC in patients treated with NUCs compared with inactive CHB is unclear.

Methods A total of 1378 patients who were treatment naïve and started NUC therapy and 1014 patients with inactive stage CHB who were HBeAg-negative and continuously had hepatitis B DNA <2000 IU/mL during follow-up were enrolled. The NUC group was divided into two groups by continuous viral suppression: NUC complete responder (CR) group and NUC incomplete responder (IR) group. Cumulative HCC incidence rates were compared between the groups.

Results The risk of developing HCC was significantly higher in the NUC CR group compared with the inactive CHB group, regardless of the presence of baseline liver cirrhosis (p<0.001). Risk factors associated with the development of HCC were treatment groups (p<0.001), age (p<0.001), sex (p<0.001) and the presence of liver cirrhosis at baseline (p=0.005). Of the NUC group, the cumulative incidence of HCC in the NUC IR group was significantly higher compared with the NUC CR group (p=0.028).

Conclusions The use of potent oral antiviral therapy can effectively suppress HBV replication in patients with CHB. However, the risk of HCC development in patients treated with oral antiviral agent is still significantly higher than patients with inactive stage CHB.

作者: StephenW 时间: 2014-11-1 17:28

肠2014年;63：1943年至1950年DOI：10.1136/ gutjnl-2013-306409

肝病

原创文章

慢性乙肝口服抗病毒治疗维持治疗肝癌的风险较高的患者与非活动期的疾病相比，

菊妍Cho1，
永瀚Paik1，
韩元Sohn1，
炫钦Cho2，
今-妍Gwak1，
月亮锡Choi1，
俊赫Lee1，
邝卓宏哲Koh1，
承焕然Paik1，
秉哲Yoo1

+作者机构

胃肠病学和肝病学，医学系，三星医疗中心，成均馆大学医学院，韩国首尔的1区
胃肠病学和肝病学，医学系，昌原三星医院，成均馆大学医学院，昌原，韩国2区

对应于教授咏涵白南准，胃肠病学和肝病科，内科，三星医疗中心，成均馆大学医学院，50 Irwon洞，江南区，首尔135-710，韩国; [email protected]

收到2013年11月9日
修订后的2014年2月2日
接受2014年2月3日
网上公布的第一2014年3月10日

抽象

背景人们普遍表示，口服抗病毒药物治疗慢性乙型肝炎（CHB）降低开发肝细胞癌（HCC）的风险。虽然口服核苷（酸）类似物（NUCs）可诱导类似于非活动期慢性乙型肝炎的状态下，与无活性的CHB相比与NUCs治疗的患者的长期风险的肝癌是不清楚的。

方法对1378例患者谁是初次接受治疗，并开始NUC治疗和1014例非活动期CHB谁是HBeAg阴性，不断有乙肝DNA<2000 IU/ mL的随访期间患者。 NUC的基团是由连续的抑制病毒分为两组：NUC完全应答（CR）的基团和不完整的NUC响应（IR）的基团。累积HCC发生率各组之间进行比较。

结果发展HCC的风险是显著更高的NUC CR组与非活动的CHB组相比，无论基线肝硬化（P <0.001）的存在。肝癌的发展有关的危险因素为治疗组（P <0.001），年龄（P <0.001），性别（P <0.001）和肝硬化的基线存在（p值=0.005）。国统组，肝癌的NUC IR组的累积发病率显著高于国统会CR组（p=0.028）相比。

结论使用强效口服抗病毒治疗能有效地抑制乙肝病毒复制的慢性乙型肝炎患者。然而，肝癌发展的患者的口服抗病毒剂治疗的风险仍然比例非活动期的CHB显著更高。

作者: 高高山顶立 时间: 2014-11-1 21:08

什么意思？

作者: 疯一点好 时间: 2014-11-1 23:44

看得头晕，什么说法都有。

作者: StephenW 时间: 2014-11-2 14:05

肝癌风险: 非活动患者 < NUC CR组(完全应答)患者 < NUC IR组(不完全响应)患者

作者: xiazhifeng0009 时间: 2014-11-2 20:59

是不是说抗病毒比不抗的癌症风险高

作者: StephenW 时间: 2014-11-2 21:20

回复 xiazhifeng0009 的帖子

是说抗病毒比不需要抗(不活跃患者) 的癌症风险高.

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