白种人肝硬化患者肝细胞癌长期乙型肝炎模拟治疗的临床特

StephenW

Clinical features and outcomes of hepatocellular carcinoma in Caucasian cirrhotic patients on long‐term analogue therapy for hepatitis B
A. Loglio
M. Iavarone
G. Grossi
M. Viganò
MG. Rumi
F. Facchetti
G. Lunghi
A. Sangiovanni
M. Colombo
P. Lampertico
First published: 19 June 2018
https://doi.org/10.1111/apt.14848

The Handling Editor for this article was Professor Peter Hayes, and it was accepted for publication after full peer‐review.
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Summary
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.
Publication cover image

Volume48, Issue4

August 2018

Pages 431-439

StephenW

白种人肝硬化患者肝细胞癌长期乙型肝炎模拟治疗的临床特征和预后
A. Loglio
M. Iavarone
G. Grossi
M.Viganò
MG。鲁米
F.法切蒂
G. Lunghi
A. Sangiovanni
科伦坡先生
P. Lampertico
首次发表：2018年6月19日
https://doi.org/10.1111/apt.14848

本文的处理编辑器是Peter Hayes教授，经过全面的同行评审后被接受发表。
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概要
背景

长期口服核苷（酸）类似物（NUC）治疗乙型肝炎病毒（HBV）相关的代偿性肝硬化可防止临床失代偿但不能发展肝细胞癌（HCC）。
目标

确定长期NUC治疗的HBV患者的HCC的临床特征和结果。
方法

研究了2005年至2016年期间接受监测的NUC治疗的HBV患者的所有HCC，不包括治疗前6个月内发生的HCC。研究了HCC，甲胎蛋白（AFP）模式和患者预后的临床特征。
结果

包括76名HCC患者。中位年龄为67（40-83）岁，84％为男性，96％为高加索人，95％为HBeAg阴性，96％为HBV DNA检测不到，83％为正常ALT水平，92％为代偿性肝硬化。中位血清AFP水平为4（1-3615）ng / mL（> 7 ng / mL，36％）。 HCC为单焦点，占78％，中位直径为20（6-57）mm，早期为92％，可以治愈78％（39％消融，28％手术切除，11％肝移植） ）。总体而言，61例（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，而16例接受肝移植（8例第二行）。在HCC诊断后45（7-144）个月期间，19名患者死亡，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是单个小肿瘤，适合于能够提供优异的5年存活率的治愈性疗法。
出版封面图片

第48卷，第4期

2018年8月

第431-439页

StephenW

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.14848