慢性病毒性肝炎和肝细胞癌患者监测和治疗后的长期生存

StephenW

Hepatol Commun. 2017 Jun 21;1(7):595-608. doi: 10.1002/hep4.1047. eCollection  2017 Sep.
Long-term survival after surveillance and treatment in patients with chronic viral hepatitis and hepatocellular carcinoma.Tong MJ1,2, Rosinski AA1, Huynh CT1, Raman SS3, Lu DSK3.
Author information
1Liver Center, Huntington Medical Research InstitutesPasadenaCA.2Pfleger Liver Institute, Division of Digestive DiseasesLos AngelesCA.3Department of Radiologic SciencesDavid Geffen School of Medicine, University of CaliforniaLos AngelesCA.

AbstractHepatocellular carcinoma (HCC) is the main cause of mortality in patients with chronic viral hepatitis (CVH). We determined the impact of surveillance and treatments on long-term outcomes in patients with CVH who developed HCC. Between 1984 and 2014, 333 patients with HCC and with hepatitis B or hepatitis C virus infection were evaluated. An adjusted lead time bias interval was added to patients with HCC who presented with HCC (no surveillance), and their survival was compared to patients whose HCC was detected by surveillance. After HCC treatments, survival rates within and beyond 3 years of follow-up were compared. In 175 (53%) patients, HCC was detected through surveillance using alpha-fetoprotein and abdominal ultrasound examinations. Compared to 158 (47%) patients with HCC who had no surveillance, more patients with HCC detected by surveillance received surgical and locoregional treatments (P <  0.0001 to P <  0.001), and their 1-, 3-, and 5-year overall and disease-free survival rates were significantly higher (P <  0.001 for both). During the first 3 years of follow-up, patients with HCC receiving liver transplantation had similar survival rates as those with liver resection or radiofrequency ablation (RFA); however, due to HCC recurrence, survival in resection and RFA patients became significantly less when followed beyond 3 years (P =  0.001 to P =  0.04). Factors associated with mortality included tumors beyond University of California at San Francisco criteria (hazard ratio [HR] 2.02; P <  0.0001), Child-Pugh class B and C (HR, 1.58-2.26; P =  0.043 to P =  0.015, respectively), alpha-fetoprotein per log ng/mL increase (HR, 1.30; P <  0.0001), previous antiviral therapy in hepatitis B virus patients (HR, 0.62; P =  0.032), and treatments other than liver transplantation (HR, 2.38-6.45; P <  0.0001 to P < 0.003). Conclusion. Patients with HCC detected by surveillance had prolonged survival. Due to HCC recurrence, survival rates after liver resection and RFA were lower when followed beyond 3 years after treatments. (Hepatology Communications 2017;1:595-608).


PMID:29404481PMCID:PMC5721434DOI:10.1002/hep4.1047

• 
  


• 
  

StephenW

Hepatol Commun。 2017年6月21日; 1（7）：595-608。 doi：10.1002 / hep4.1047。 eCollection 2017年9月
慢性病毒性肝炎和肝细胞癌患者监测和治疗后的长期生存。
Tong MJ1,2，Rosinski AA1，Huynh CT1，Raman SS3，Lu DSK3。
作者信息

1
    亨廷顿医学研究所的肝脏中心PaasdenaCA。
2
    Pfleger肝脏研究所，消化疾病司洛杉矶CA。
3
    加利福尼亚大学洛杉矶分校放射科学系David Geffen医学院。

抽象

肝细胞癌（HCC）是慢性病毒性肝炎（CVH）患者死亡的主要原因。我们确定了监测和治疗对发生HCC的CVH患者长期预后的影响。在1984年至2014年期间，评估了333名HCC患者和乙型肝炎或丙型肝炎病毒感染者。调整前置时间偏差区间被添加到患有HCC的HCC患者（无监视），并将其存活与通过监视检测到HCC的患者进行比较。 HCC治疗后，比较3年以内和以后的生存率。在175例（53％）患者中，通过使用甲胎蛋白和腹部超声检查进行监测发现HCC。与158例（47％）HCC无监测的患者相比，接受手术和局部治疗的HCC患者更多（P <0.0001至P <0.001），总的1年，3年和5年和无病生存率显着高于两者（P <0.001）。在随访的前3年，接受肝移植的肝癌患者的生存率与肝切除或射频消融术（RFA）相似;然而，由于HCC复发，随访3年以上（P = 0.001〜P = 0.04），切除和RFA患者的生存率明显降低。与死亡率有关的因素包括加州大学旧金山分校以外的肿瘤标准（危险比[HR] 2.02; P <0.0001），Child-Pugh B级和C级（HR 1.58-2.26; P = 0.043至P = 0.015 ），甲胎蛋白升高（HR，1.30; P <0.0001），既往乙肝病毒抗病毒治疗（HR，0.62; P = 0.032）和肝移植以外的治疗（HR，2.38- 6.45; P <0.0001至P <0.003）。结论。通过监测发现HCC的患者存活时间延长。由于HCC复发，肝切除和RFA治疗后3年以上的生存率较低。 （Hepatology Communications 2017; 1：595-608）。

结论：
    29404481
PMCID：
    PMC5721434
DOI：
    10.1002 / hep4.1047