慢性乙型肝炎患者发生肝细胞癌复发的风险与抗病毒二级预

StephenW

PLoS One. 2017 Nov 27;12(11):e0188552. doi: 10.1371/journal.pone.0188552. eCollection  2017.
Risk of recurrence in chronic hepatitis B patients developing hepatocellular carcinoma with antiviral secondary prevention failure.Lee IC1,2,3, Chau GY4, Yeh YC5, Chao Y6, Huo TI1,7, Su CW1,2,3, Lin HC1, Hou MC1,2, Huang YH1,2,3.
Author information
1Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.2Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.3Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.4Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.5Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.6Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.7Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.

AbstractBACKGROUND: Nucleos(t)ide analogues (NUCs) treatment can reduce the risk of hepatocellular carcinoma (HCC) development and recurrence in chronic hepatitis B (CHB) patients. However, the risk of recurrence in CHB patients who develop HCC despite NUC treatment remains unclear.
METHODS: 167 consecutive CHB patients receiving curative resection for HCC with NUC therapy after surgery were retrospectively enrolled. Thirty-eight patients who developed HCC despite NUC therapy for more than 1 year were defined as secondary prevention failure. The other 129 patients started NUC therapy after surgery. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were evaluated.
RESULTS: The 5-year RFS and OS rates were 44.7% and 77.3%, respectively. Sex, BMI, BCLC stage, AFP levels and cirrhosis status were the independent predictors of RFS, while microvascular invasion was the independent predictor of OS. The RFS was comparable between patients with and without NUC secondary prevention. In the subgroup analysis, the RFS was significantly worse in cirrhotic patients with secondary prevention failure (hazard ratio = 2.373, p = 0.009). Secondary prevention failure did not have adverse impact on OS. Among 84 patients with recurrence, 58.3% of the cases remained in BCLC stage A, and 53.6% received a second curative treatment. Long-term NUC therapy may lead to a decline of non-invasive indices of hepatic fibrosis in HCC patients.
CONCLUSIONS: In general, the risk of recurrence and survival are comparable between patients with and without secondary prevention failure. However, a higher risk of recurrence was observed in cirrhotic patients with secondary prevention failure.


PMID:29176777DOI:10.1371/journal.pone.0188552

StephenW

PLoS One。 2017年11月27日; 12（11）：e0188552。 doi：10.1371 / journal.pone.0188552。 eCollection 2017。
慢性乙型肝炎患者发生肝细胞癌复发的风险与抗病毒二级预防失败。
Lee IC1,2,3，GY4，Yey YC5，Chao Y6，霍TI1,7，Su CW1,2,3，Lin HC1，Hou MC1,2，Huang YH1,2,3。
作者信息

1
    台北市退伍军人总医院医学科消化内科及肝病科。
2
    台湾台北国立阳明大学医学院医学系。
3
    国立阳明大学临床医学研究所台湾台北
4
    台北退伍军人医院外科台湾台北
五
    台北市退伍军人总医院病理科和检验医学系，台北。
6
    台北退伍军人医院癌症中心台北。
7
    台湾台北国立阳明大学医学院药理研究所。

抽象
背景：

核苷（酸）类似物（NUCs）治疗可降低慢性乙型肝炎（CHB）患者肝细胞癌（HCC）发展和复发的风险。然而，尽管NUC治疗发生HCC的CHB患者复发的风险仍不清楚。
方法：

回顾性分析167例CHB患者术后接受根治性切除的HCC及NUC治疗。将NUC治疗1年以上发生HCC的38例患者定义为二级预防失败。另外129例患者在术后开始NUC治疗。评估与无复发生存（RFS）和总生存（OS）有关的因素。
结果：

5年的RFS和OS率分别为44.7％和77.3％。性别，BMI，BCLC分期，AFP水平和肝硬化状态是RFS的独立预测因子，而微血管侵犯是OS的独立预测因子。无论是否进行NUC二级预防，RFS都相当。在亚组分析中，肝硬化患者二级预防失败的RFS显着更差（风险比= 2.373，p = 0.009）。二级预防失败对OS没有不利影响。 84例复发患者中，BCLC A期患者中有58.3％保留，53.6％的患者接受第二次治愈。长期NUC治疗可能导致HCC患者肝纤维化非侵袭性指标的下降。
结论：

一般而言，有和无二级预防失败的患者复发和生存的风险相当。然而，在二级预防失败的肝硬化患者中观察到更高的复发风险。

结论：
    29176777
DOI：
    10.1371 / journal.pone.0188552

StephenW

http://journals.plos.org/plosone ... ournal.pone.0188552