抗病毒治疗可能下调B型肝炎联肝癌复发

StephenW

Antiviral Therapy May Cut Recurrence of Hepatitis B-Linked Liver Cancer
Patients who received the drugs after surgery seemed to do better, study found
November 12, 2012 RSS Feed Print

MONDAY, Nov. 12 (HealthDay News) -- People with liver cancer tied to infection with the hepatitis B virus who got antiviral therapy after cancer surgery had a lower risk of tumor recurrence than those who did not get it, according to a new study.

"Hepatitis B infection commonly leads to the development of liver cancer in patients with and without cirrhosis," explained one expert not connected to the study, Dr. David Bernstein, chief of the division of hepatology at North Shore University Hospital in Manhasset, N.Y.

He also noted that antiviral therapy is now standard practice for these patients. Most experts "agree that all patients with hepatitis B and liver cancer, whether cirrhosis is present or not, and any level of the hepatitis B virus in the blood should be treated with antiviral therapy," Bernstein said.

In the new study, Taiwanese researchers compared results for more than 4,500 patients who had surgery for hepatitis B virus-related liver cancer between 2003 and 2010. The treated group consisted of about 500 patients who received antiviral therapy (drugs called nucleoside analogues) after surgery, while the remainder received no antiviral therapy.

The treated group had half the rate of cancer recurrence compared to the untreated group (21 percent vs. 44 percent) and a lower death rate (11 percent vs. 28 percent), according to the team led by Dr. Chun-Ying Wu, of National Yang-Ming University in Taipei.

Over six years, the risk of liver cancer recurrence was 46 percent in the treated group and 55 percent in the untreated group, while the risk of death was 29 percent in the treated group and more than 42 percent in the untreated group.

Treated patients, however, had a higher rate of liver cirrhosis: 49 percent vs. 39 percent.

The researchers calculated that antiviral therapy reduced the risk of cancer recurrence by a third overall. The use of cholesterol-lowering statin drugs also was associated with about a third less risk, and the use of painkillers such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with a 20 percent reduced risk.

The study, published online Nov. 12 in the Journal of the American Medical Association, also was scheduled for presentation Monday at the annual meeting of the American Association for the Study of Liver Diseases, in Boston.

Bernstein cautioned that, in his opinion, the study had some flaws.

"The most important is the lack of data regarding the hepatitis B viral load in both the treated and untreated patient groups," he said. He said information on viral load is important, since "there may be a subset of patients with cirrhosis and no detectable hepatitis B virus in the blood who develop liver cancer, [and] it is difficult to recommend hepatitis B treatment in this group."

"The second major flaw is the short duration of follow-up," Bernstein said.

Still, he said, the "take-home message" from the study supports the "current standard of care, which is that all patients with liver cancer secondary to hepatitis B and detectable hepatitis B virus should be treated with oral antiviral therapy, as these therapies are safe, effective and have minimal side effects."

Another expert agreed.

"This new information is extremely valuable," said Dr. Peter Malet, director of the Center for Liver Diseases at Winthrop-University Hospital in Mineola, N.Y.

"Treatment of chronic hepatitis B with an oral medication is actually standard of care now," Malet noted, and "the available medications are taken once a day, are safe and have minimal side effects."

He said that, in most cases, insurance should cover the cost of antiviral medications. But he also stressed that most cases of primary liver cancers are not triggered by hepatitis B infection, and few liver tumors are amenable to surgery.

"The actual number of patients in the United States to whom this approach applies is rather small," he said.

More information

The U.S. National Cancer Institute has more about hepatitis B.

Copyright © 2012 HealthDay. All rights reserved.

StephenW

抗病毒治疗可能下调的B型肝炎联肝癌复发
研究发现手术后患者谁收到的药物似乎做的更好，
11月12日，2012 RSS Feed打印

11月12日（星期一）（HealthDay新闻） - 绑在了抗病毒治疗癌症手术后有较低的肿瘤复发的风险比那些没有得到它的人与B型肝炎病毒感染与肝癌的人，根据一项新的研究。

“B型肝炎感染通常会导致患者无肝硬化和肝癌的发展，一位专家解释说：”没有连接的研究，戴维·伯恩斯坦博士，在纽约州Manhasset北岸大学医院首席肝病的划分

他还指出，对这些患者，抗病毒治疗是目前的标准做法。大多数专家同意，所有患者是否与B型肝炎和肝癌，肝硬化存在与否，应被视为与任何级别的B型肝炎病毒在血液中的抗病毒治疗，“伯恩斯坦说。

在新的研究中，台湾研究人员比较了4500多例，手术治疗B型肝炎病毒有关的肝癌在2003年和2010年之间。治疗组包括约500名病人在手术后接受抗病毒治疗（药物核苷类似物），其余的则没有接受抗病毒药物治疗。

有一半的癌症复发率治疗组相比，治疗组（21％对44％）和较低的死亡率（11％比28％），根据吴春英博士领导的研究小组，国立阳明大学，台北。

六年，肝癌复发的风险为46％，对照组和治疗组的55％，而死亡的风险为29％，治疗组和超过42％的治疗组。

接受治疗的患者，然而，有较高的肝硬化：49％比39％。

研究人员计算的第三次整体的抗病毒治疗，减少癌症复发的风险。降低胆固醇的他汀类药物的使用也减少了三分之一风险，使用止痛药，如阿司匹林和非甾体类抗炎药（NSAIDs）与20％的风险降低。

，在线11月12日发表在美国医学协会杂志的研究，也被定为演示周一在肝脏疾病的研究，在波士顿的美国协会的年度会议。

伯恩斯坦提醒说，在他看来，这项研究有一定的缺陷。

“最重要的是缺乏关于乙肝病毒载量的处理和未经处理的病人群体的数据，”他说。他说，病毒载量的信息是很重要的，因为“有可能是肝硬化患者的一个子集，并没有检测乙肝病毒在血液中发展为肝癌，[和]这是困难的，建议B型肝炎的治疗方法本组”。

“第二个主要缺陷是持续时间短的跟进，”伯恩斯坦说。

不过，他说，“带回家的消息”的研究支持“现行标准的护理，这是所有二次B型肝炎和检测B型肝炎病毒与肝癌的患者应接受口服抗病毒药物治疗，因为这些疗法是安全，有效，副作用也小。“

另一位专家对此表示同意。

“这个新的信息是非常宝贵的，博士说：”肝病中心主任彼得·马利特，在温斯洛普大学医院的Mineola，NY

“现在实际上是标准的护理治疗慢性B型肝炎的口服药物，”马利特指出，“现有的药物服用，每日一次，是安全的，有最小的副作用。”

他说，在大多数情况下，保险应覆盖成本的抗病毒药物。但他同时强调，大多数情况下，原发性肝癌的B型肝炎病毒感染引发的，和一些肝肿瘤是可以手术的。

“这种方法适用于在美国患者的实际数量是相当小的，”他说。

更多信息

美国国家癌症研究所B型肝炎

版权所有©2012大纪元。保留所有权利。