慢性乙型肝炎相关的肝细胞癌减少用抗病毒治疗，包括低风

StephenW

Aliment Pharmacol Ther. 2016 Aug 23. doi: 10.1111/apt.13774. [Epub ahead of print]
Reduction of chronic hepatitis B-related hepatocellular carcinoma with anti-viral therapy, including low risk patients.Lin D1, Yang HI2,3, Nguyen N4,5, Hoang J4, Kim Y4, Vu V4, Le A4, Chaung K4,6, Nguyen V4,6, Trinh H7, Li J8, Zhang J9, Hsing A10,11, Chen CJ2,12, Nguyen MH4.
Author information

• 1Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
• 2Genomics Research Center, Academia Sinica, Taipei, Taiwan.
• 3Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
• 4Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
• 5Department of Medicine, University of California San Diego, San Diego, CA, USA.
• 6Pacific Health Foundation, San Jose, CA, USA.
• 7San Jose Gastroenterology, San Jose, CA, USA.
• 8Mountain View Division, Palo Alto Medical Foundation, Mountain View, CA, USA.
• 9Chinese Hospital, San Francisco, CA, USA.
• 10Stanford Cancer Institute, Stanford School of Medicine, Palo Alto, CA, USA.
• 11Health Research and Policy Department, Stanford School of Medicine, Standford, CA, USA.
• 12Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
  

AbstractBACKGROUND: Anti-viral therapy in chronic hepatitis B (CHB) is associated with a reduced risk of hepatocellular carcinoma (HCC) primary described in patients with cirrhosis.
AIMS: To examine the effects of treatment on HCC incidence in CHB with and without cirrhosis, after adjustment for background risks.
METHODS: A total of 2255 CHB patients from a US cohort (973 received anti-viral therapy) and 3653 patients from the community-based Taiwanese REVEAL-HBV study, none of whom received treatment. We used Cox proportional hazard models to calculate the risk of developing HCC after adjustment with the previously validated REACH-B risk score.
RESULTS: We found 273 incident cases of HCC. After adjustment, therapy lowered the risk of HCC development in the US treated cohort when compared to the US untreated cohort (HR 0.31; 95% CI: 0.15-0.66; P = 0.002). HCC risk reduction was also confirmed when compared to the REVEAL cohort (HR 0.22; 95% CI: 0.12-0.40; P < 0.001). Each REACH-B point was associated with a 53% increased risk of HCC (HR 1.53; 95% CI 1.46-1.59; P < 0.001). We found a significant statistical reduction in HCC incidence with therapy regardless of gender, age, cirrhosis status, HBeAg serology, alanine aminotransferase level, REACH-B score or treatment medication. Therapy was beneficial to those with mildly- to moderately elevated HBV DNA levels (>2000 IU/mL) and of even greater benefit to those with levels >200 000 IU/mL.
CONCLUSIONS: After adjustment for background risk, anti-viral therapy was associated with a significant reduction in HCC incidence in both community and real-life clinical cohorts, including in those patients previously thought to be at low risk.
© 2016 John Wiley & Sons Ltd.


PMID:27549411DOI:10.1111/apt.13774

StephenW

滋养品药理疗法。 2016年23月DOI：10.1111 / apt.13774。 [打印EPUB提前]
慢性乙型肝炎相关的肝细胞癌减少用抗病毒治疗，包括低风险的患者。
林D1，杨HI2,3，阮N4,5，晃J4，金Y4，武V4，A4乐，羌K4,6，阮V4,6，郑氏H7，李J8，J9张，幸A10,11，陈CJ2,12，阮MH4。
作者信息

    医药，斯坦福大学医学中心，帕洛阿尔托，CA，USA教研室。
    2Genomics研究中心，中央研究院，台湾台北。
    临床医学，国立阳明大学，台北，台湾3Institute。
    胃肠病学和肝病，斯坦福大学医学中心，帕洛阿尔托，CA，USA的4Division。
    医学，加州大学圣地亚哥分校，圣地亚哥，CA，USA的5Department。
    6Pacific健康基金会，圣何塞，CA，USA。
    7San何塞消化内科，圣何塞，CA，USA。
    8Mountain查看司，帕洛阿尔托医学基金会，山景，CA，USA。
    9Chinese医院，旧金山，CA，USA。
    10Stanford癌症研究所，医学院的斯坦福学院，帕洛阿尔托，CA，USA。
    11Health研究和政策部，医学，斯坦福，加州，美国斯坦福学院。
    国立台湾大学流行病学研究所12Graduate与预防医学，台湾台北。

抽象
背景：

在慢性乙型肝炎（CHB）的抗病毒治疗与患者主述肝硬化肝细胞癌的风险降低（HCC）相关联。
目的：

为了有和没有肝硬化的检查治疗对肝癌发病率慢性乙型肝炎的影响，调整背景风险后。
方法：

共有来自美国队列2255 CHB患者（973接受抗病毒治疗），3653例患者从社区为基础的台湾REVEAL-HBV研究中，没有一个人接受治疗。我们使用Cox比例风险模型来计算与先前验证的REACH-B的风险分数调整后显影肝癌的风险。
结果：

我们发现肝癌的273例发生。调整后，与美国相比，未处理的队列时，降低治疗在美国治疗肝癌人群开发的风险（HR 0.31; 95％CI：0.15-0.66; P = 0.002）。相比REVEAL队列时，肝癌的风险降低也证实（HR 0.22; 95％CI：0.12-0.40; P <0.001）。每个REACH-B点与肝癌的53％的风险增加（HR 1.53; 95％CI 1.46-1.59; P <0.001）。我们发现在肝癌发生率显著减少统计与治疗不分性别，年龄，肝硬化状态，血清学e抗原，谷丙转氨酶水平，REACH-B的分数或治疗药物。疗法是对那些与mildly-到中度升高HBV DNA水平有利（> 2000国际单位/毫升），以及更大的好处对那些与水平> 200 000国际单位/毫升。
结论：

调整背景风险后，抗病毒治疗与社区和现实生活中的临床队列在肝癌发生率显著减少有关，包括以前被认为是低风险的患者。

2016年©约翰·威利父子有限公司

结论：
    27549411
DOI：
    10.1111 / apt.13774

使命123

是说低风险的抗病毒后肝癌的发生率也减少了？

StephenW

使命123 发表于 2016-8-25 15:14
是说低风险的抗病毒后肝癌的发生率也减少了？

是 - 不清楚低风险是什么? hbvdna > 2,000 & < 20,000 iu/ml?

StephenW

"In subgroup analysis, our results showed that patients
with strong and independent predictors of increased
HCC risk,4–6, 16 including male gender, older age, cirrhosis and high REACH-B scores, have all benefi ted from
treatment. Importantly, we also found benefit from treatment in subjects who were historically considered to
have low HCC risk factors, such as female gender,
younger age, lack of cirrhosis, HBeAg negativity, normal
to minimally elevated ALT levels, and low-to-middle
REACH-B scores (<14). While technically considered to
be at low risk, these patients still have a tangible risk of
HCC and may also benefit from anti-viral treatment.
Studies have shown that as many as 40% of immune tolerant patients with persistently normal ALT levels still
have evidence of significant fibrosis or inflammation on
biopsy.33, 34
It should also be noted that, while anti-viral
therapy can reduce HCC risk, it does not eliminate the
risk completely and treated patients should continue to
undergo HCC surveillance.35
In addition, viral suppression induced  by anti-viral therapy does not mean cure
and long-term or lifelong therapy is often indicated, as
HBVcure with HBsAg seroclearance is a very rare event
in treated as well as untreated adult HBV pat ients, especially among Asian patients."
“以子组ANA裂解，我们的结果显示，患者
具有较强的独立预测因素增加
肝癌的风险4-6，包括16男性，年龄较大，肝硬化和高REACH-B的分数，有来自好处特德
治疗。重要的是，我们还发现好处牛逼从治疗中谁被历史视为科目
具有低的肝癌的危险因素，如女性，
年龄小，缺乏肝硬化和HBeAg阴性，正常
到轻微升高的ALT水平，并低到中间
REACH-B的分数（<14）。虽然在技术上被认为
在低风险，这些病人仍然有一个切实的风险
肝癌并可以从抗病毒治疗也好处吨。
有研究表明，免疫耐受的患者多达40％与ALT持续正常水平仍
有显着的纤维化或在佛罗里达州ammation证据
biopsy.33，34
还应当指出的是，尽管抗病毒
治疗可降低肝癌风险，这并不排除
完全风险和治疗的患者应继续
经过HCC surveillance.35
此外，抑制病毒诱导的抗病毒治疗并不意味着固化
和长期或终身疗法通常所指出的，如
HBVcure与乙肝表面抗原血清学清除是一种非常罕见的事件
在处理以及未经处理的成人HBV拍拍ients，特别是在亚洲患者“。


"In summary, this large cohort of 5908 CHB patients
demonstrated that treatment with anti-viral therapy was
statistically significant and independently associated with
lower HCC risk after comprehensive adjustment for
background risk. Treatment was associated with a large
77% HCC risk reduction in patients with only modestly
elevated HBV DNA levels ( > 2000 IU/mL) regardless of
differences in gender, age, cirrhosis status, HBeAg status,
ALT level, REACH-B scores or treatment medication."

“总之，这个大型队列5908 CHB患者
证实具有抗病毒疗法治疗是
统计学显着的，独立关联
全面调整后降低肝癌风险
背景风险。治疗用大有关
77％的肝癌风险降低患者仅略有
升高的HBV DNA水平（> 2000国际单位/毫升），而不管
在性别差异，年龄，肝硬化状态，HBeAg状态，
ALT水平，REACH-B的分数或治疗药物。“

baobao7676

抗病毒大大降低患HCC的风险，哪怕是低HBVDNA（>2000IU/ml和和高HBVDNA(>200000IU/ml)的，高的得益尤其明显。