抗病毒治疗抑制病毒重新激活和改善生存后重复肝切除术乙

StephenW

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        J Am Coll Surg. 2016 Dec 3. pii: S1072-7515(16)31662-3. doi: 10.1016/j.jamcollsurg.2016.11.009. [Epub ahead of print]
Antiviral Therapy Inhibits Viral Reactivation and Improves Survival after Repeat Hepatectomy for Hepatitis B Virus-Related Recurrent Hepatocellular Carcinoma.Huang S1, Xia Y1, Lei Z1, Zou Q2, Li J1, Yang T1, Wang K2, Yan Z1, Wan X3, Shen F4.
Author information

• 1Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• 2Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• 3Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• 4Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: [email protected].
  

AbstractBACKGROUND: To explore the impact of antiviral therapy (AVT) on short- and long-term outcomes after re-hepatectomy for patients with recurrent HBV-related hepatocellular carcinoma (HCC).
STUDY DESIGN: The data of 583 consecutive patients who underwent re-hepatectomy for intrahepatic recurrence of HBV-related HCC after initial hepatectomy between 2006 and 2011 at the Eastern Hepatobiliary Surgery Hospital were analyzed. Tumor re-recurrence, recurrence to death survival (RTDS) and overall survival (OS) were compared using the Kaplan-Meier method and log-rank test. The independent risk factors of prognoses were analyzed using the Cox proportional hazards model. The postoperative viral reactivation, surgical morbidity and mortality were also observed.
RESULTS: Preoperative AVT reduced viral reactivation rate after re-hepatectomy (5.8% for AVT patients, 16.3% and 16.6% for non-AVT patients with viral level ≤ or >2000 IU/mL, respectively, p≤0.028). Viral reactivation and non-AVT were independent risk factors of tumor re-recurrence (hazard ratios: 1.446 and 1.778), RTDS (1.691 and 2.457) and OS (1.781 and 1.857). AVT improved long-term outcomes as compared with non-AVT with a viral level of ≤ or >2000IU/mL (5-year re-recurrence rate: 69% vs. 81% vs. 96%, respectively; 5-year RTDS rate: 47% vs. 27% vs. 17%, respectively, all p ≤ 0.016). Pre- plus postoperative AVT achieved a better 5-year OS rate than postoperative AVT alone (83% vs. 60%, p=0.045), while they had insignificant differences in 5-year re-recurrence and RTDS rates (61% vs. 77%, p=0.102; 50% vs. 44%, p=0.395).
CONCLUSIONS: Preoperative AVT decreased viral reactivation rate. AVT initiated either before or after re-hepatectomy contributed to better long-term prognoses after re-hepatectomy for recurrent HBV-related HCC.

Copyright © 2016. Published by Elsevier Inc.

KEYWORDS: antiviral therapy; hepatocellular carcinoma; prognosis; re-hepatectomy; recurrence; viral reactivation

PMID:27923614DOI:10.1016/j.jamcollsurg.2016.11.009

StephenW

格式：摘要

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J Am Coll Surg。 2016 Dec 3. pii：S1072-7515（16）31662-3。 doi：10.1016 / j.jamcollsurg.2016.11.009。 [打印前的电子版]
抗病毒治疗抑制病毒重新激活和改善生存后重复肝切除术乙型肝炎病毒相关的复发性肝细胞癌。
Huang S1，Xia Y1，Lei Z1，Zou Q2，Li J1，Yang T1，Wang K2，Yan Z1，Wan X3，Shen F4。
作者信息

    摘要：第二军医大学东方肝胆外科医院肝外科四期。
    2第二军医大学东方肝胆外科医院肝外科二室，上海。
    3第二军医大学东方肝胆外科医院临床数据库，中国上海。
    摘要：第二军医大学东方肝胆外科医院肝外科四室，上海。电子地址：[email protected]。

抽象
背景：

探讨抗病毒治疗（AVT）对复发性HBV相关性肝细胞癌（HCC）患者肝切除术后短期和长期预后的影响。
学习规划：

分析了2006年至2011年在东部肝胆外科医院进行初始肝切除术后583例连续接受肝切除术的HBV相关HCC肝内复发患者的数据。使用Kaplan-Meier方法和对数秩检验比较肿瘤复发，死亡生存复发（RTDS）和总生存（OS）。使用Cox比例风险模型分析预后的独立危险因素。还观察到术后病毒再激活，手术发病率和死亡率。
结果：

术前AVT降低再肝切除术后的病毒再激活率（AVT患者为5.8％，非AVT患者分别为16.3％和16.6％，病毒水平≤或> 2000 IU / mL，p≤0.028）。病毒再激活和非AVT是肿瘤复发的独立危险因素（风险比：1.446和1.778），RTDS（1.691和2.457）和OS（1.781和1.857）。与病毒水平≤或> 2000IU / mL的非AVT相比，AVT改善了长期预后（5年复发率分别为69％，81％和96％; 5年RTDS率：47％对27％对17％，所有p≤0.016）。术前AVT术后AVT获得了更好的5年OS率（83％vs 60％，p = 0.045），而5年复发率和RTDS率则无显着差异（61％vs. 77％，p = 0.102; 50％对44％，p = 0.395）。
结论：

术前AVT降低病毒再激活率。 AVT在再肝切除术之前或之后引起，对于复发性HBV相关HCC，在肝切除术后具有更好的长期预后。

版权所有©2016.由Elsevier Inc.发布
关键词：

抗病毒治疗;肝细胞癌;预后;再肝切除术;复发病毒再激活

PMID：
    27923614
DOI：
    10.1016 / j.jamcollsurg.2016.11.009