长期使用口服核苷（t）ide类似物用于慢性乙型肝炎并不会增

StephenW

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
Authors

    First published: 27 February 2017Full publication history
    DOI: 10.1111/apt.14015  View/save citation
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    Article has an altmetric score of 1
   
    The Handling Editor for this article was Professor Geoffrey Dusheiko, and it was accepted for publication after full peer-review.

Summary
Background

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.

StephenW

长期使用口服核苷（t）ide类似物用于慢性乙型肝炎并不会增加癌症风险 - 44 494名受试者的队列研究
作者

    首次发布：2017年2月27日全文出版历史
    DOI：10.1111 / apt.14015查看/保存引用
    引用（CrossRef）：0篇文章检查更新

    文章的高分为1分
   
    这篇文章的处理编辑是Geoffrey Dusheiko教授，经过全面的同行评议，被接受出版。

概要
背景

患有慢性乙型肝炎（CHB）的患者需要用核苷类似物（NA）进行长期抗病毒治疗。动物研究表明，一些NA可能会增加癌症的风险，但缺乏人类的数据。
目标

调查患者有无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队伍研究。 CHB和各种恶性肿瘤的诊断是基于2000年至2012年的国际疾病分类，第九修订，临床修改（ICD-9-CM）诊断代码。包括暴露于CHB的任何口服NA的患者。主要结果是事件性癌症。使用3年的里程碑分析，随访时间长达7年，用于评估治疗和未治疗患者癌症的相对危险度。
结果

分析中共纳入44 494例患者（39 712例未治疗和4782例治疗）。在194 890例患者年随访期间，402例（1.0％）未治疗患者和179例（3.7％）治疗患者发生肝细胞癌，其他癌症分别在528例（1.3％）和128例（2.7％）患者中发展。治疗组患者倾向评分加权后，所有恶性肿瘤的风险相似[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。鉴于对肝脏结局有益的影响，我们的数据支持了目前长期抗病毒治疗的实践。