四年期恩替卡韦治疗减少慢性乙型肝炎患者的肝细胞癌，肝

StephenW

Liver International
Four-Year Entecavir Therapy Reduces Hepatocellular Carcinoma, Cirrhotic Events and Mortality in Chronic Hepatitis B Patients

Tung-Hung Su; Tsung-Hui Hu; Chi-Yi Chen; Yi-Hsiang Huang; Wan-Long Chuang; Chun-Che Lin; Chia-Chi Wang; Wei-Wen Su; Ming-Yao Chen; Cheng-Yuan Peng; Rong-Nan Chien; Yi-Wen Huang; Horng-Yuan Wang; Chih-Lin Lin; Sheng-Shun Yang; Tsung-Ming Chen; Lein-Ray Mo; Shih-Jer Hsu; Kuo-Chih Tseng; Tsai-Yuan Hsieh; Fat-Moon Suk; Chi-Tan Hu; Ming-Jong Bair; Cheng-Chao Liang; Yung-Chao Lei; Tai-Chung Tseng; Chi-Ling Chen; Jia-Horng Kao
Disclosures


    Add Other Topics

Abstract and Introduction
Abstract

Background & Aims: Oral antiviral therapy may reduce the disease progression of chronic hepatitis B (CHB) patients. We aimed to further investigate the efficacy of long-term entecavir therapy in reduction of the risk of hepatocellular carcinoma (HCC), cirrhotic events and mortality in a large group of CHB-related cirrhosis patients.

Methods: The C-TEAM (Cirrhosis-Taiwanese EntecAvir Multicenter) study was a nationwide, multicenter, retrospective–prospective cohort study in Taiwan. We enrolled treatment-naïve patients with CHB-related cirrhosis and baseline HBV-DNA≥2000 IU/mL receiving long-term entecavir therapy and compared the development of HCC, cirrhotic events and mortality with that of a historical untreated cohort.

Results: In total, 1315 entecavir-treated and 503 untreated patients with cirrhosis were enrolled, with median treatment and follow-up durations of 4 and 6 years respectively. Compared with the untreated cohort, entecavir therapy was associated with a 60% HCC risk reduction [hazard ratio (HR): 0.40, 95% confidence interval (CI): 0.28–0.57]. Additionally, an older age, the male gender, HBeAg positivity, alpha-fetoprotein (AFP)≥7 ng/mL before therapy were independent predictors of HCC development. Further analysis showed that entecavir therapy significantly reduced risks of variceal bleeding, spontaneous bacterial peritonitis, and liver-related and all-cause mortality. These findings were confirmed by propensity score-matched cohorts in sensitivity analysis. In patients under entecavir therapy, an older age, the male gender, HBeAg positivity, AFP level ≥7 ng/mL before therapy, and 1-year virological response were predictive of HCC development.

Conclusions: Four-year entecavir therapy significantly reduces the risk of HCC, cirrhotic events and mortality in patients with CHB-related cirrhosis.

StephenW

肝脏国际
四年期恩替卡韦治疗减少慢性乙型肝炎患者的肝细胞癌，肝硬化事件和死亡率

董洪鸿;胡庆辉陈志义黄晓祥;万龙庄;陈春林王志奇韦文文;陈耀耀;程元源荣南建黄文文;王角元;林林林杨盛顺陈明明Lein-Ray Mo;什叶派Kuo-Chih Tseng;蔡元谢肥月月胡锦涛;明榕白程超超杨超超大涌井;陈志凌Jia-Horng Kao
披露


    添加其他主题

摘要与介绍
抽象

背景与目的：口服抗病毒治疗可以减少慢性乙型肝炎（CHB）患者的疾病进展。我们的目的是进一步调查长期恩替卡韦治疗在减少肝细胞癌（HCC）的风险，肝硬化事件和死亡率的大型CHB相关肝硬化患者的疗效。

方法：C-TEAM（肝硬化 - 台湾EntecAvir多中心）研究是一个全国性，多中心，回顾性前瞻性队列研究在台湾。我们招收了治疗初期的CHB相关性肝硬化患者和基线HBV-DNA≥2000IU / mL接受长期恩替卡韦治疗，并将HCC，肝硬化事件和死亡率的发展与历史未治疗队列的发展进行比较。

结果：总共1315名恩替卡韦治疗和503名未经治疗的肝硬化患者入选，中位数治疗和随访时间分别为4和6年。与未治疗的队列相比，恩替卡韦治疗与60％的HCC风险降低[风险比（HR）：0.40,95％置信区间（CI）：0.28-0.57]相关。此外，治疗前年龄较大，男性，HBeAg阳性，甲胎蛋白（AFP）≥7ng / mL是HCC发展的独立预测因素。进一步分析显示恩替卡韦治疗显着降低了静脉曲张出血，自发性细菌性腹膜炎，肝脏相关性和全因死亡的风险。这些发现在倾向评分匹配队列在敏感性分析中得到证实。在恩替卡韦治疗的患者中，较大年龄，男性，HBeAg阳性，治疗前AFP水平≥7ng/ mL和1年病毒学应答预示着HCC发展。

结论：四年恩替卡韦治疗显着降低CHB相关肝硬化患者肝癌，肝硬化事件和死亡的风险。