抗病毒治疗开始时，聚乙二醇干扰素和核苷酸（核苷酸）类

StephenW

J Viral Hepat. 2019 Nov 21. doi: 10.1111/jvh.13236. [Epub ahead of print]
Peg-interferon and nucleos(t)ide analogue combination at inception of antiviral therapy improves both anti-HBV efficacy and long-term survival among HBV DNA positive hepatocellular carcinoma patients after hepatectomy/ablation.
Qi W1, Zhang Q1, Xu Y1, Wang X1, Yu F1, Zhang Y1, Zhao P1, Guo H1, Zhou C1, Wang Z1, Sun Y2, Liu L2, Xuan W3, Wang J1.
Author information

1
    Digestive Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
2
    Invasive Technology Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
3
    Hepatobiliary surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.

Abstract

Antiviral therapy has been shown to improve the prognosis of hepatitis B virus (HBV) DNA-positive hepatocellular carcinoma (HCC) after radical treatment, but antiviral treatments require further optimization. This study aimed to evaluate the efficacies of different antiviral strategies with HCC patients after hepatectomy/ablation. This prospective, randomized, controlled, and multi-center trial enrolled HBV DNA-positive primary HCC patients after hepatectomy/ablation between January 2007 and January 2009. Patients were divided into four groups: early-combination (entecavir plus Peg-interferon [IFN]α-2a co-administration during year 1); late-combination (addition of Peg-IFNα-2a for 48 weeks after 1 year of entecavir); nucleos(t)ide analogue[NA] monotherapy; and non-antiviral treatment. Primary endpoints included recurrence-free survival and overall survival. A total of 447 patients were enrolled. The 2-year and 8-year recurrence free survival and 8-year overall survival rates were significantly higher in the early-combination group than in the other two antiviral groups (P<0.05). After 48 weeks treatment, more patients achieved an HBsAg reduction >1500 IU/ml and the mean HBsAg level was significantly lower in the early-combination group compared with the late-combination and NA monotherapy groups (P<0.05). Multivariate analysis showed that early-combination therapy and a reduction in HBsAg by >1500 IU/mL after 48 weeks of therapy correlated with reduced mortality and disease recurrence. Early introduction of combination antiviral treatment may represent a more effective therapeutic strategy for patients with HBV DNA-positive HCC after hepatectomy/ablation. A reduction in HBsAg by >1500 IU/mL after 48 weeks treatment is associated with reduced mortality and disease recurrence of HBV DNA-positive HCC patients after hepatectomy/ablation.

© 2019 John Wiley & Sons Ltd.
KEYWORDS:

(MeSH)s interferon; Drug Combinations; hepatitis B virus; hepatocellular carcinoma; prognosis

PMID:
    31755220
DOI:
    10.1111/jvh.13236

StephenW

J病毒性肝炎。 2019年11月21日.doi：10.1111 / jvh.13236。 [Epub提前发布]
抗病毒治疗开始时，聚乙二醇干扰素和核苷酸（核苷酸）类似物组合可改善肝切除/消融后HBV DNA阳性的肝细胞癌患者的抗HBV疗效和长期生存率。
齐W1，张Q1，徐Y1，王X1，于F1，张Y1，赵P1，郭H1，周C1，王Z1，孙Y2，刘L2，轩W3，王J1。
作者信息

1个
    吉林大学中日联合医院消化科，吉林长春
2
    吉林大学中日联合医院侵袭技术系，吉林长春
3
    吉林大学中日联合医院肝胆外科，吉林长春

抽象

根治后，抗病毒治疗已显示可改善乙型肝炎病毒（HBV）DNA阳性肝细胞癌（HCC）的预后，但抗病毒治疗需要进一步优化。本研究旨在评估肝切除/消融后不同抗病毒策略对HCC患者的疗效。这项前瞻性，随机，对照和多中心试验纳入了2007年1月至2009年1月间肝切除/消融后HBV DNA阳性的原发性HCC患者。患者分为四组：早期联合治疗（恩替卡韦加聚乙二醇干扰素[IFN]第1年）中的α-2a共同给药；后期联合治疗（恩替卡韦治疗1年后加用Peg-IFNα-2a48周）；核苷类似物[NA]单一疗法；和非抗病毒治疗。主要终点包括无复发生存期和总生存期。共有447位患者入组。早期联合治疗组的2年和8年无复发生存率和8年总生存率显着高于其他两个抗病毒组（P <0.05）。在治疗48周后，与晚期联合治疗和NA单一治疗组相比，早期联合治疗组有更多的患者HBsAg降低> 1500 IU / ml，并且平均HBsAg水平显着降低（P <0.05）。多因素分析表明，早期联合治疗和治疗48周后HBsAg降低> 1500 IU / mL与降低死亡率和疾病复发相关。对于肝切除/消融后HBV DNA阳性的HCC患者，尽早引入抗病毒治疗可能是一种更有效的治疗策略。治疗48周后HBsAg降低> 1500 IU / mL，与肝切除/消融后HBV DNA阳性HCC患者的死亡率降低和疾病复发相关。

©2019 John Wiley＆Sons Ltd.
关键字：

（MeSH）干扰素；药物组合；乙型肝炎病毒；肝细胞癌；预后

PMID：
    31755220
DOI：
    10.1111 / jvh.13236