口服核苷（酸）类似物降低慢性乙肝相关的肝癌复发和死亡

StephenW

Aliment Pharmacol Ther. 2016 Feb 4. doi: 10.1111/apt.13548. [Epub ahead of print]
Oral nucleos(t)ide analogues reduce recurrence and death in chronic hepatitis B-related hepatocellular carcinoma.Wong GL1,2,3, Tse YK1,2, Chan HL1,2,3, Yip TC4, Tsoi KK5, Wong VW1,2,3.
Author information

• 1Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
• 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
• 3State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
• 4Department of Statistics, The Chinese University of Hong Kong, Hong Kong.
• 5Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong.
  

AbstractBACKGROUND: In patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC), high viral load was associated with tumour recurrence and deaths.
AIMS: To investigate the effect of nucleos(t)ide analogues (NA) on the clinical outcomes after different HCC treatments.
METHODS: A territory-wide cohort study was conducted using the database from Hospital Authority. We identified CHB patients with HCC by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in 2000-2012. HCC treatments, NA use and laboratory parameters were retrieved. The primary endpoint was HCC recurrence and death. A 3-month landmark analysis was used to evaluate the primary outcome in patients with or without NA treatment.
RESULTS: A total of 2198 CHB patients (1230 NA-untreated and 968 NA-treated) with HCC, receiving at least one type of HCC treatment were included in the analysis. At a median follow-up of 2.8 (IQR 1.4-4.9) years, tumour recurrence and death occurred in 451 (36.7%) and 578 (47.0%) untreated patients; and in 216 (22.3%) and 301 (31.1%) NA-treated patients respectively. NA therapy reduced the risk of overall HCC recurrence [adjusted sub-hazard ratio (SHR) 0.63, 95% confidence interval (CI) 0.49-0.80; P < 0.001]. The effect was most obvious in patients undergoing resection (SHR = 0.58, 95% CI = 0.37-0.91, P = 0.018). The possibility of NA therapy reducing the risk of death (HR = 0.82, 95% CI = 0.64-1.03, P = 0.092), is most obvious in resection subgroup (HR = 0.64, 95% CI = 0.41-0.99, P = 0.050) but insignificant in the other treatment groups.
CONCLUSION: Our findings show that nucleos(t)ide analogues treatment reduces the risk of HCC recurrence in patients with chronic hepatitis B treated by surgical resection.
© 2016 John Wiley & Sons Ltd.

StephenW

滋养品药理疗法。 2016年4月DOI：10.1111 / apt.13548。 [打印EPUB提前]
口服核苷（酸）类似物降低慢性乙肝相关的肝癌复发和死亡。
黄GL1,2,3，谢霆锋YK1,2，陈HL1,2,3，TC4叶，蔡KK5黄VW1,2,3。
消化系统疾病，中国香港大学，香港作者信息1Institute。中国的香港大学，香港内科及药物治疗，教研室。消化疾病的香港中国香港大学国家重点实验室，。中国的香港大学，香港统计系。 5Big数据决策分析研究中心，香港中国大学，香港。
抽象
背景：
在慢性乙型肝炎（CHB）相关肝细胞癌（HCC），高病毒载量与肿瘤复发和死亡有关。
目的：
为了研究对临床结果核苷（酸）类似物（NA）不同的肝癌治疗后的效果。
方法：
一个全港性队列研究使用来自医院管理局数据库中进行。我们发现CHB患者肝癌的疾病，第九版，临床修订（ICD-9-CM）诊断编码的国际分类中2000-2012。肝癌的治疗，NA的使用和实验室参数进行检索。主要终点是肝癌复发和死亡。 3个月具有里程碑意义的分析来评估患者有无NA治疗的主要成果。
结果：
共有2198 CHB患者（1230 NA-未处理和968 NA处理）与肝癌，接收至少一种类型的肝癌的治疗被纳入分析。在2.8（IQR 1.4-4.9）年的中位随访，肿瘤复发和死亡发生在451（36.7％）和578（47.0％）未经治疗的患者;在216（22.3％）和301例（31.1％）分别为NA治疗的患者。 NA治疗降低了总肝癌复发[校正子的危险比（SHR）0.63，95％置信区间（CI）0.49-0.80的风险; P <0.001。效果在患者接受切除术（SHR = 0.58，95％CI = 0.37-0.91，P = 0.018）最为明显。 NA治疗降低死亡风险的可能性（HR = 0.82，95％CI = 0.64-1.03，P = 0.092），在切除组（HR = 0.64，95％CI = 0.41-0.99最为明显，P = 0.050 ），但在其他治疗组微不足道。
结论：
我们的研究结果表明，核苷（酸）类似物治疗降低肝癌复发的慢性乙型肝炎手术切除治疗的风险。
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