肝硬化患者肝细胞癌长期模拟治疗的临床特点和疗效

StephenW

Aliment Pharmacol Ther. 2018 Jun 19. doi: 10.1111/apt.14848. [Epub ahead of print]
Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long-term analogue therapy for hepatitis B.
Loglio A1, Iavarone M1, Grossi G1, Viganò M2, Rumi MG2, Facchetti F1, Lunghi G3, Sangiovanni A1, Colombo M4, Lampertico P1.
Author information

1
    CRC "A.M. e A. Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
2
    Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
3
    Virology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
4
    Center for Translational Hepatology Research, Clinical and Research Center, Humanitas Hospital, Rozzano, Italy.

Abstract
BACKGROUND:

Long-term oral nucleos(t)ide analogue (NUC) therapy in hepatitis B virus (HBV)-related compensated cirrhotics prevents clinical decompensation but not hepatocellular carcinoma (HCC) development.
AIMS:

To define the clinical features and outcomes of HCC in long-term NUC-treated HBV patients.
METHODS:

All HCCs developing between 2005 and 2016 in NUC-treated HBV patients under surveillance were studied, excluding those that occurred within the first 6 months of therapy. Clinical features of HCC, alpha faetoprotein (AFP) patterns and patients' outcome were studied.
RESULTS:

Seventy-six HCC patients were included. Median age was 67 (40-83) years, 84% males, 96% Caucasian, 95% HBeAg-negative, 96% with undetectable HBV DNA, 83% with normal ALT levels, and 92% with compensated cirrhosis. Median serum AFP levels were 4 (1-3615) ng/mL (>7 ng/mL in 36%). HCC was monofocal in 78%, had a median diameter of 20 (6-57) mm and was in its early stage in 92% which allowed potentially curative treatments in 78% (39% ablation, 28% surgical resection, 11% liver transplantation). Overall, a complete response was obtained in 61 (80%) patients: in 40 after a first-line treatment, in 3 after the second-line treatment, in 2 after the third-line treatment, while 16 underwent liver transplantation (8 as second line). During 45 (7-144) months after HCC diagnosis, 19 patients died, 84% from HCC progression. The median time to recurrence was 20.2 (3-53) months, and the cumulative 5-year liver-related survival was 74%.
CONCLUSIONS:

HCCs developing in patients under long-term NUC treatment were single, small tumours, amenable to curative therapies able to confer excellent 5-year survival rates.

© 2018 John Wiley & Sons Ltd.

PMID:
    29920698
DOI:
    10.1111/apt.14848

StephenW

Aliment Pharmacol Ther。 2018年6月19日doi：10.1111 / apt.14848。 [电子版提前打印]
肝硬化患者肝细胞癌长期模拟治疗的临床特点和疗效
Loglio A1，Iavarone M1，Grossi G1，ViganòM2，Rumi MG2，Facchetti F1，Lunghi G3，Sangiovanni A1，Colombo M4，Lampertico P1。
作者信息

1
    CRC“A.M. e A. Migliavacca”肝病研究中心，胃肠病学和肝病学部，Fondazione IRCCSCàGranda Ospedale Maggiore Policlinico，意大利米兰大学米兰大学。
2
    意大利米兰Universitàdegli Studi di Milano，意大利Ospedale San Giuseppe医院肝病科。
3
    Virology Unit，Fondazione IRCCSCàGranda Ospedale Maggiore Policlinico，意大利米兰Universitàdegli Studi di Milano，米兰。
4
    意大利罗扎诺市Humanitas医院临床研究中心转化肝病研究中心。

抽象
背景：

乙型肝炎病毒（HBV）相关代偿性肝硬化的长期口服核苷（酸）类似物（NUC）疗法预防临床失代偿而不是肝细胞癌（HCC）的发展。
目的：

为了确定HUC在长期NUC治疗的HBV患者中的临床特征和结局。
方法：

在NUC治疗的HBV患者监测下，在2005年至2016年期间发展的所有HCC都进行了研究，不包括治疗前6个月内发生的HCC。研究了HCC的临床特征，α甲胎蛋白（AFP）模式和患者的结局。
结果：

纳入了76例HCC患者。中位年龄67（40-83）岁，男性84％，高加索人96％，HBeAg阴性95％，HBV DNA检测不到96％，ALT水平正常83％，代偿性肝硬化92％。中位血清AFP水平为4（1-3615）ng / mL（36％时> 7ng / mL）。 HCC单发78％，中位直径为20（6-57）mm，早期为92％，78％有可能进行治愈性治疗（39％消融，28％手术切除，11％肝移植）。总体而言，61名（80％）患者获得完全缓解：一线治疗后40例，二线治疗后3例，三线治疗后2例，16例接受肝移植（8例第二行）。 HCC诊断后45（7-144）个月内，19例患者死亡，84％来自HCC进展。中位复发时间为20.2（3-53）个月，累计5年肝脏相关生存率为74％。
结论：

在长期NUC治疗的患者中发展的HCC是单一的小肿瘤，适合能够赋予优异的5年生存率的治愈性疗法。

©2018 John Wiley＆Sons Ltd.

结论：
    29920698
DOI：
    10.1111 / apt.14848