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本帖最后由 StephenW 于 2011-8-4 13:58 编辑
Hepatocellular carcinoma in chronic hepatitis B patients on antiviral treatment with virological suppression
S GHALY, K BU, K YAN, L CHOO, J GEORGE, F CHU, S STRASSER, A ZEKRY
St. George Hospital Gastroenterology Department, AW Morrow Gastroenterology and Liver Center, Royal Prince Alfred Hospital, Storr Liver Unit, Westmead Hospital
Effective viral suppression with antiviral therapy has been shown to reduce
the development of hepatocellular carcinoma (HCC) in hepatitis B virus
(HBV) infected patients. Scarce data exist however, on the group of
patients who still develop HCC despite achieving good HBV viral suppression
with therapy. We aimed therefore, to characterise the risks and
predictors for the development of HCC in this patient cohort.
Methods This is a multicentre, retrospective analysis of HCC development
in chronic hepatitis B over a 10-year period. HBV infected
patients who achieved viral suppression (defined by HBV DNA < 200 IU/
ml persistently) on antiviral therapy and who developed HCC were
identified from hospital records. Clinical, biochemical, virological and
histological characteristics at the time of commencement of, and during,
antiviral therapy were reviewed. In comparison, a randomly selected
sample of HBV infected patients with cirrhosis and viral suppression on
antiviral therapy who did not develop HCC during follow-up were
reviewed. Comparators included: age, sex, race, HBV status, and therapy
history.
Results
245 patients with hepatitis B-related HCC were identified. Of
these, 31 patients with good viral suppression on antiviral therapy were
identified. This group was compared to 31 HBV patients with virological
suppression without HCC development. Among the overall 62 patients,
mean age at commencement of antiviral therapy was 53.9 ± 10.9 and 48
(77.4%) were male. Forty-five (72.6%) were Asians with the remainder
principally of European background. The median follow-up was 30 (range
1–155) months. Among the HCC group, 44% were cirrhotic at starting
therapy. By univariate analysis, those who developed HCC were more
likely to be male, age >60 and HBeAg negative (p < 0.05). Survival analysis
demonstrated that either, switching to or, adding-on second line antiviral
therapy to achieve viral suppression was associated with HCC
development (Hazard Ratio 2.5, 95% confidence interval 1.1–5.4).
Conclusions
In HBV patients with viral suppression on antiviral therapy,
older age, male gender, HBeAg negative disease and the necessity to
either, switch to or, add in second line antiviral therapy was associated
with subsequent HCC development. Therefore, use of first line antiviral
agents with rapid, sustained viral suppression and low resistance with
targeted, intense HCC screening of this population is recommended.
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发表于 2011-8-4 09:06
