长期使用口服核苷（t）ide类似物的慢性乙型肝炎不会增加癌

StephenW

Aliment Pharmacol Ther. 2017 Feb 27. doi: 10.1111/apt.14015. [Epub ahead of print]
Long-term use of oral nucleos(t)ide analogues for chronic hepatitis B does not increase cancer risk - a cohort study of 44 494 subjects.Wong GL1,2,3, Tse YK1,2, Yip TC4, Chan HL1,2,3, Tsoi KK5, Wong VW1,2,3.
Author information

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

AbstractBACKGROUND: Patients with chronic hepatitis B (CHB) need long-term antiviral treatment with nucleos(t)ide analogues (NA). Animal studies suggest that some NA may increase cancer risk, but human data are lacking.
AIM: To investigate cancer risks in patients with or without NA treatment.
METHODS: We conducted a territory-wide cohort study using the database from Hospital Authority in Hong Kong. The diagnosis of CHB and various malignancies was based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes between 2000 and 2012. Patients exposed to any of the oral NA for CHB were included. The primary outcome was incident cancers. A 3-year landmark analysis, with follow-up up to 7 years, was used to evaluate the relative risk of cancers in treated and untreated patients.
RESULTS: A total of 44 494 patients (39 712 untreated and 4782 treated) were included in the analysis. During 194 890 patient-years of follow-up, hepatocellular carcinoma developed in 402 (1.0%) untreated patients and 179 (3.7%) treated patients, while other cancers developed in 528 (1.3%) and 128 (2.7%) patients respectively. After propensity score weighting, treated patients had similar risks of all malignancies [weighted hazard ratio (wHR): 1.01, 95% CI: 0.82-1.25, P = 0.899], lung/pleural cancers (wHR: 0.82, 95% CI: 0.52-1.31, P = 0.409) and urinary/renal malignancies (wHR: 1.04, 95% CI: 0.38-2.81, P = 0.944) when compared with untreated patients.
CONCLUSIONS: Oral nucleos(t)ide analogue treatment does not appear to increase cancer risk in patients with chronic hepatitis B. Given the beneficial effect on liver outcomes, our data support the current practice of long-term anti-viral therapy.

© 2017 John Wiley & Sons Ltd.

PMID:28239880DOI:10.1111/apt.14015

StephenW

Aliment Pharmacol Ther。 2017年2月27日。doi：10.1111 / apt.14015。 [打印前的电子版]
长期使用口服核苷（t）ide类似物的慢性乙型肝炎不会增加癌症的风险 - 队列研究44 494科目。
Wong GL1,2,3，Tse YK1,2，Yip TC4，Chan HL1,2,3，Tsoi KK5，Wong VW1,2,3。
作者信息

    1消化病研究所，香港中文大学，香港，中国。
    2香港中文大学医学与治疗学院，香港，中国。
    3消化疾病国家重点实验室，香港中文大学，香港，中国。
    4香港中文大学香港中文大学统计学系。
    数据决策分析研究中心，香港中文大学，香港，中国。

抽象
背景：

慢性乙型肝炎（CHB）患者需要长期抗病毒治疗与核苷类似物（NA）。动物研究表明，一些NA可能增加癌症风险，但人类数据缺乏。
目标：

研究患有或不伴NA治疗的患者的癌症风险。
方法：

我们使用香港医院管理局的数据库进行全港性队列研究。 CHB和各种恶性肿瘤的诊断基于2000年至2012年期间的国际疾病分类，第九修订版，临床修正（ICD-9-CM）诊断代码。包括了暴露于任何口腔NA的CHB的患者。主要结果是事件性癌症。使用3年标志性分析，随访至多7年，用于评估治疗和未治疗患者的癌症的相对风险。
结果：

总共44 494例患者（39 712未经处理和4782治疗）包括在分析中。在194 890患者年的随访期间，在402（1.0％）未治疗的患者和179（3.7％）治疗的患者中发展成肝细胞癌，而分别在528（1.3％）和128（2.7％）患者中发展其他癌症。倾向评分加权后，治疗的患者具有所有恶性肿瘤的相似风险[加权风险比（wHR）：1.01,95％CI：0.82-1.25，P = 0.899]，肺/胸膜癌（wHR：0.82,95％CI：0.52 -1.31，P = 0.409）和尿/肾恶性肿瘤（wHR：1.04,95％CI：0.38-2.81，P = 0.944）。
结论：

口服核苷类似物治疗似乎不会增加慢性乙型肝炎患者的癌症风险。鉴于对肝脏结果的有益影响，我们的数据支持长期抗病毒治疗的当前实践。

©2017 John Wiley＆Sons Ltd.

PMID：
    28239880
DOI：
    10.1111 / apt.14015