肝细胞癌放疗后乙型肝炎病毒再激活和抗病毒治疗的疗效：

StephenW

PLoS One. 2018 Jul 30;13(7):e0201316. doi: 10.1371/journal.pone.0201316. eCollection 2018.
Hepatitis B virus reactivation after radiotherapy for hepatocellular carcinoma and efficacy of antiviral treatment: A multicenter study.
Jun BG1, Kim YD1, Kim SG2, Kim YS2, Jeong SW3, Jang JY3, Lee SH4, Kim HS4, Kang SH5, Kim MY5, Baik SK5, Lee M6, Kim TS6, Choi DH6, Choi SH7, Suk KT7, Kim DJ7, Cheon GJ1.
Author information

1
    Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
2
    Department of Internal Medicine, Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, South Korea.
3
    Department of Internal Medicine, Soonchunhyang University College of Medicine Seoul Hospital, Seoul, South Korea.
4
    Department of Internal Medicine, Soonchunhyang University College of Medicine Cheonan Hospital, Cheonan, South Korea.
5
    Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
6
    Department of Internal medicine, Kangwon National University Hospital, Chuncheon, South Korea.
7
    Department of Internal Medicine Hallym University College of Medicine, Chuncheon, South Korea.

Abstract

Convincing data that support routine use of preventive therapy against hepatitis B virus (HBV) reactivation in radiotherapy (RT) for hepatocellular carcinoma (HCC) are lacking. The aim of this study was to investigate the incidence, clinical significance, and risk factors of HBV reactivation after RT. Medical records of 133 HBsAg (+) HCC patients who received radiotherapy from March 2009 to February 2016 were reviewed. Patients were divided into two groups: 1) non-antiviral group, those who did not receive antiviral therapy before RT (n = 27); and antiviral group (those who underwent antiviral therapy before RT) (n = 106). Factors related to HBV reactivation in HCC patients were evaluated. 17 (12.7%) of 133 patients developed HBV reactivation after RT. Patients in the antiviral group had significantly lower rates of HBV reactivation than those in the non-antiviral group (7.5% vs. 33.3%, p<0.001). HBV related hepatitis was also lower in the antiviral group (3.8% vs. 14.8%, p = 0.031). In multivariate analysis, absence of antiviral treatment (OR: 8.339, 95% CI: 2.532-27.470, p<0.001) and combined treatment of RT with transarterial chemoembolizatoin (TACE) (OR: 5.313, 95% CI: 1.548-18.232, p = 0.008) were risk factors for HBV reactivation. HBV reactivation can occur after radiotherapy. Combination treatment of RT with TACE and non-antiviral treatment are major risk factors for HBV reactivation during or after RT. Therefore, preventive antiviral therapy should be recommended for patients with HCC who are scheduled to receive RT.

PMID:
    30059513
DOI:
    10.1371/journal.pone.0201316

StephenW

PLoS One。 2018年7月30日; 13（7）：e0201316。 doi：10.1371 / journal.pone.0201316。 eCollection 2018。
肝细胞癌放疗后乙型肝炎病毒再激活和抗病毒治疗的疗效：一项多中心研究。
Jun BG1，Kim YD1，Kim SG2，Kim YS2，Jeong SW3，Jang JY3，Lee SH4，Kim HS4，Kang SH5，Kim MY5，Baik SK5，Lee M6，Kim TS6，Choi DH6，Choi SH7，Suk KT7，Kim DJ7 ，Cheon GJ1。
作者信息

1
    蔚山大学医学院内科，韩国江陵江陵牙山医院。
2
    韩国富川市顺天乡大学医学院内川医院内科。
3
    Soonchunhyang大学医学院内科，韩国首尔首尔医院。
4
    Soonchunhyang University医学院内科，韩国天安市天安医院。
五
    延世大学内科，韩国原州原州医学院。
6
    韩国春川江原国立大学医院内科
7
    韩国春川市Hallym大学医学院内科。

抽象

缺乏令人信服的数据支持常规使用针对肝细胞癌（HCC）的放射治疗（RT）中的乙型肝炎病毒（HBV）再激活的预防性治疗。本研究的目的是调查RT后HBV再激活的发生率，临床意义和危险因素。对2009年3月至2016年2月接受放疗的133例HBsAg（+）HCC患者的病历进行了回顾。患者分为两组：1）非抗病毒组，RT组前未接受抗病毒治疗的组（n = 27）;和抗病毒治疗组（那些在转诊前接受抗病毒治疗的人）（n = 106）。评估了与HCC患者中HBV再激活相关的因素。 133例患者中有17例（12.7％）在室温下发生HBV再激活。抗病毒组患者的HBV再激活率显着低于非抗病毒组（7.5％vs。33.3％，p <0.001）。抗病毒组的HBV相关性肝炎也较低（3.8％对14.8％，p = 0.031）。在多变量分析中，没有抗病毒治疗（OR：8.339,95％CI：2.532-27.470，p <0.001）和RT与经动脉化学栓塞（TACE）的联合治疗（OR：5.313,95％CI：1.548-18.232，p = 0.008）是HBV再激活的危险因素。放疗后可发生HBV再激活。 RT与TACE和非抗病毒治疗的联合治疗是在RT期间或之后HBV再激活的主要风险因素。因此，对于预定接受RT治疗的HCC患者，应推荐预防性抗病毒治疗。

结论：
    30059513
DOI：
    10.1371 / journal.pone.0201316