抗病毒治疗可降低HBV-DNA水平低的患者的肝细胞癌复发：随机

StephenW

Ann Surg. 2018 Mar 8. doi: 10.1097/SLA.0000000000002727. [Epub ahead of print]
Antiviral Therapy Reduces Hepatocellular Carcinoma Recurrence in Patients With Low HBV-DNA Levels: A Randomized Controlled Trial.
Huang G1, Li PP1, Lau WY1,2, Pan ZY1, Zhao LH1, Wang ZG1, Wang MC1, Zhou WP1.
Author information

1
    Eastern Hepatobiliary Surgery Hospital, National Innovation Alliance for Hepatitis and Liver Cancer, Shanghai, China.
2
    Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, People's Republic of China.

Abstract
BACKGROUND:

Despite antiviral treatment has been shown to reduce hepatocellular carcinoma (HCC) recurrence after curative treatment for hepatitis B virus (HBV)-related HCC in patients with high preoperative HBV-DNA levels, it is still unclear whether antiviral therapy is useful in reducing recurrence in patients with low preoperative HBV-DNA levels.
METHODS:

In this randomized controlled trial, 200 patients who underwent curative resection for HCC with low baseline HBV-DNA levels were randomly assigned to receive preemptive antiviral therapy or not. The primary endpoints were recurrence-free survival. This study was censored on March 31, 2015 when all surviving patients had a minimum follow-up of 60 months. The analysis was done on an intention-to-treat basis.
RESULTS:

The baseline clinical, laboratory, and tumor characteristics of the 2 groups were comparable. The 1-, 3-, and 5-year recurrence-free survival rates for the antiviral group and the control group were 85.9%, 55.2%, and 52.0% and 80.6%, 40.9%, and 32.3%, respectively. The corresponding overall survival rates for the 2 groups were 94.0%, 75.7%, and 64.1% and 90.0%, 62.4%, and 43.7%, respectively. The recurrence-free survival and overall survival for the antiviral group were significantly better than the control group (P = 0.016, P = 0.004, respectively). After adjusting for confounding prognostic factors in a Cox model, the relative risks of recurrence and death for antiviral treatment were 0.601 [95% confidence interval (CI), 0.409-0.884; P = 0.010] and 0.509 (95% CI, 0.333-0.778; P = 0.002), respectively. Antiviral therapy was an independent protective factor of late tumor recurrence (hazard ratio [HR] = 0.316, 95% CI 0.157-0.637; P = 0.001) but not of early tumor recurrence (HR = 0.782, 95% CI, 0.493-1.240; P = 0.296).
CONCLUSIONS:

In patients with low preoperative HBV-DNA levels, antiviral therapy significantly reduced HCC recurrence after R0 hepatic resection.

PMID:
    29521740
DOI:
    10.1097/SLA.0000000000002727

StephenW

Ann Surg。 2018年3月8日，doi：10.1097 / SLA.0000000000002727。 [电子版提前打印]
抗病毒治疗可降低HBV-DNA水平低的患者的肝细胞癌复发：随机对照试验。
Huang G1，Li PP1，Lau WY1,2，Pan ZY1，Zhao LH1，Wang ZG1，Wang MC1，Zhou WP1。
作者信息

1
东方肝胆外科医院，国家肝炎和肝癌创新联盟，中国上海。
2
香港中文大学医学院，香港特别行政区沙田威尔斯亲王医院。

抽象
背景：

尽管在术前HBV-DNA水平高的患者接受乙肝病毒（HBV）相关HCC治疗后，抗病毒治疗已经减少至肝细胞癌（HCC）复发，但抗病毒治疗是否有助于减少患者复发仍然不清楚术前HBV-DNA水平低。
方法：

在这项随机对照试验中，200名接受治疗性肝癌切除的低基线HBV-DNA水平的患者被随机分配接受预先接受的抗病毒治疗或不接受。主要终点是无复发生存。这项研究于2015年3月31日进行了审查。所有存活患者的最低随访时间为60个月。分析是在意向治疗的基础上完成的。
结果：

两组的基线临床，实验室和肿瘤特征相当。抗病毒组和对照组的1年，3年和5年无复发生存率分别为85.9％，55.2％和52.0％。两组相应的总生存率分别为94.0％，75.7％，64.1％和90.0％，62.4％和43.7％。而调整抗病毒组显着优于对照组（P = 0.016，P = 0.004，分别）。在对Cox模型中混杂的预后因素进行校正后，抗病毒治疗的相对复发和死亡风险为0.601 [95％置信区间（CI）为0.409-0.884; P = 0.010]和0.509（95％CI，0.333-0.778; P = 0.002）。抗病毒治疗是晚期肿瘤复发的独立保护因素（风险比[HR] = 0.316,95％CI 0.157-0.637; P = 0.001），但不是早期肿瘤复发（HR = 0.782,95％CI 0.493-1.240; P = 0.296）。
结论：

在术前HBV-DNA水平低的患者中，抗病毒治疗显着降低R0肝切除术后HCC复发。

结论：
29521740
DOI：
10.1097 / SLA.0000000000002727