肝癌的发病率减少长期核苷（酸）类似物IDE治疗慢性乙型肝

StephenW

The incidence of hepatocellular carcinoma is reduced in patients with chronic hepatitis B on long-term nucleos(t)ide analogue therapy

    C. S. Coffin*,
    M. Rezaeeaval,
    J. X. Pang,
    L. Alcantara,
    P. Klein,
    K. W. Burak and
    R. P. Myers

Article first published online: 13 OCT 2014

DOI: 10.1111/apt.12990

Vol. 40 Issue 10
Alimentary Pharmacology & Therapeutics


Summary
Background

North American data are lacking on the effect of nucleos(t)ide analogues (NA) in preventing chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC).
Aim

To determine the incidence of HCC in NA-treated patients and compare this risk with that predicted without treatment based on the REACH-B model.
Methods

In this retrospective study, the incidence of HCC was determined in CHB patients initiated on NA from 1999 to 2012. Pre-treatment data utilised in the REACH-B model were used to predict the annual HCC risk. The standardised incidence ratio (SIR) for HCC was calculated by comparing the observed to expected number of cases, and HCC risk factors determined by Cox proportional hazards regression.
Results

Five hundred and forty nine initiated NA (14% lamivudine, 5% adefovir, 1.5% telbivudine, 39% entecavir, 41% tenofovir). Over a median follow-up of 3.2 years (IQR 1.9–4.6), 11 (3.2%) were diagnosed with HCC. Among 322 with data to calculate the REACH-B model, the median age at treatment initiation was 46 years (IQR 38–55), 65% were male, 32% HBeAg positive and 20% had cirrhosis. The median pre-treatment ALT was 71 U/L (IQR 41–127) and HBV DNA was 6.48 log10 copies/mL (4.95–8.04). The observed annual HCC incidence (0.9%; 95% CI 0.5–1.7) was significantly lower than predicted without treatment by the REACH-B model (SIR 0.46; 95% CI 0.23–0.82); this risk was reduced after 4 years of therapy (SIR 0.49; 95% CI 0.2–1.00).
Conclusions

In this Canadian study of nucleos(t)ide analogues-treated patients with chronic hepatitis B, the incidence of HCC was lower than expected, suggesting that NA reduce the risk of chronic hepatitis B-related HCC.

StephenW

肝癌的发病率减少长期核苷（酸）类似物IDE治疗慢性乙型肝炎患者

C. S.科芬*
M. Rezaeeaval，
J.十庞，
L.阿尔坎塔拉，
P.克莱因，
K. W·布拉克和
R. P.迈尔斯

文章首先发表在网上：二○一四年十月十三日

DOI：10.1111/ apt.12990

卷。 40第10期
消化系统药理学与治疗学


摘要
背景

北美的数据缺乏对核苷（酸）类似物（NA）的预防慢性乙型肝炎（CHB）的影响 - 相关肝细胞癌（HCC）。
目的

为了确定肝癌的NA治疗的患者的发病率，并比较与预测没有治疗基础上，REACH-B型这方面的风险。
方法

在这项回顾性研究，肝癌的发病率开始在北美从1999年到在REACH-B型采用2012年的前处理数据的乙肝患者被确定被用来预测每年肝癌的风险。肝癌标化发病比（SIR）进行了计算和比较观察到的情况下预期的数量和肝癌的危险因素所决定的Cox比例风险回归。
结果

五百49发起NA（14％拉米夫定，5％阿德福韦，1.5％替比夫定，39％恩替卡韦，41％替诺福韦）。在中位随访3.2年（IQR1.9-4.6），11（3.2％）被诊断为肝癌。在322的数据来计算的REACH-B型，平均年龄在治疗开始为46岁（IQR38-55），65％为男性，32％的HBeAg阳性和20％有肝硬化。中位治疗前ALT71 U / L（IQR41-127）和HBV-DNA为6.48 log10拷贝/毫升（4.95-8.04）。观察每年肝癌发病率（0.9％，95％CI0.5-1.7）是显著下不用治疗的REACH-B型（SIR0.46，95％CI0.23-0.82）比预期;这种风险在经过4年的治疗（95％CI为0.2-1.00 SIR0.49）减少。
结论

在核苷这个加拿大的研究（）类似物治疗慢性乙型肝炎，肝癌的发生率较预期为低，这表明NA降低慢性乙肝相关肝癌的风险。