恩替卡韦和替诺福韦比其他抗病毒药物更有效地减少乙型肝

StephenW

J Viral Hepat. 2018 Jan 6. doi: 10.1111/jvh.12855. [Epub ahead of print]
Entecavir and Tenofovir Reduce Hepatitis B Virus-related Hepatocellular Carcinoma Recurrence More Effectively than Other Antivirals.Cho H1, Ahn H1, Lee DH1,2, Lee JH1, Jung YJ2, Chang Y1, Nam JY1, Cho YY1, Lee DH3, Cho EJ1, Yu SJ1, Lee JM3, Kim YJ1, Yoon JH1.
Author information
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.2Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.3Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

AbstractNucleos(t)ide analogues (NAs) have been shown to decrease the risk of hepatocellular carcinoma (HCC) recurrence. This study evaluated whether high-potency NAs (entecavir and tenofovir disoproxil fumarate [TDF]) reduce the risk of tumor recurrence more potently than low-potency NAs after curative treatment of hepatitis B virus (HBV)-related HCC. This study included 607 consecutive HBV-related HCC patients treated with surgical resection or radiofrequency ablation. The patients were categorized into three groups according to antiviral treatment: group A (no antiviral; n=261), group B (low-potency NA; n=90), and group C (high-potency NA; n=256). The primary endpoint was recurrence-free survival (RFS). During the duration of follow-up, the median RFS was 29.4, 25.1, and 88.2 months in groups A, B, and C, respectively (P<0.001, log-rank test). The multivariate Cox analysis indicated that group C had a significantly longer RFS than both group A (adjusted hazard ratio [HR]=0.39, P<0.001) and group B (adjusted HR=0.47, P<0.001). When baseline characteristics were balanced using inverse probability weighting, group C still had a significantly longer RFS than group A (adjusted HR=0.46, P<0.001) and group B (adjusted HR=0.59, P=0.007). Group C had significantly lower risk of viral breakthrough than group B (HR=0.19, P<0.001). Viral breakthrough was an independent risk factor for shorter RFS among groups B and C (adjusted HR=2.03, P=0.007, time-dependent Cox analysis). Antiviral agents with high genetic barrier to resistance (entecavir and TDF) reduced the risk of HCC recurrence compared with other antivirals and no antiviral treatment, especially in patients with high baseline viral load. This article is protected by copyright. All rights reserved.


KEYWORDS: Antiviral agents; Hepatocellular carcinoma; Radiofrequency ablation; Relapse; Resection

PMID:29316069DOI:10.1111/jvh.12855

StephenW

J病毒肝脏。 2018年1月6日doi：10.1111 / jvh.12855。 [电子版提前打印]
恩替卡韦和替诺福韦比其他抗病毒药物更有效地减少乙型肝炎病毒相关的肝细胞癌复发。
Cho H1，Ahn H1，Lee DH1,2，Lee JH1，Jung YJ2，Chang Y1，Nam JY1，Cho YY1，Lee DH3，Cho EJ1，Yu SJ1，Lee JM3，Kim YJ1，Yoon JH1。
作者信息

1
韩国首尔首尔国立大学医学院内科和肝脏研究所。
2
首尔大都市政府内科首尔大学Boramae医疗中心，韩国首尔。
3
首尔大学医学院放射科，韩国首尔。

抽象

这项研究表明，与乙型肝炎病毒（HBV）相关的HCC治疗后，高效力的NAs（替莫唑胺和替诺福韦二吡呋酯富马酸盐[TDF]）是否比低效力的NAs更有效地降低肿瘤复发的风险。本研究包括607例连续接受手术切除或射频消融治疗的HBV相关HCC患者。根据抗病毒治疗将患者分为三组：A组（无抗病毒剂，261例），B组（低效力NA，90例）和C组（高效NA，256例）随访时间，A，B和C组的中位RFS分别为29.4,25.1和88.2个月（P <0.001，对数秩检验）。多变量Cox分析显示，C组的RFS显着长于A组（调整后的危险比[HR] = 0.39，P <0.001），B组（调整后的HR = 0.47，P <0.001）。当使用反概率加权平衡基线特征时，C组仍然具有比A组显着更长的RFS（校正HR = 0.46，= 0.59，P = 0.007）。 C组病毒突破的风险显着低于B组（HR = 0.19，P <0.001）。病毒性突破是B，C组RFS较短的独立危险因素，P = 0.007，时间依赖性Cox分析）。抗病毒药物（恩替卡韦和TDF）具有较高的遗传障碍，与其他抗病毒药物相比，降低了HCC复发的风险，并且没有抗病毒治疗，特别是基线病毒载量高的患者。本文受版权保护。版权所有。
关键词：

抗病毒药物;肝细胞癌;射频消融;复发;切除

结论：
29316069
DOI：
10.1111 / jvh.12855