乙型肝炎病毒相关性肝细胞癌术前抗病毒治疗与微血管侵犯

StephenW

JAMA Surg. 2018 Aug 1:e182721. doi: 10.1001/jamasurg.2018.2721. [Epub ahead of print]
Association of Preoperative Antiviral Treatment With Incidences of Microvascular Invasion and Early Tumor Recurrence in Hepatitis B Virus-Related Hepatocellular Carcinoma.
Li Z1, Lei Z1, Xia Y1, Li J1, Wang K1, Zhang H1, Wan X1, Yang T1, Zhou W1, Wu M1, Pawlik TM2, Lau WY3, Shen F1.
Author information

1
    Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
2
    Department of Surgery, Wexner Medical Center, Ohio State University, Columbus.
3
    Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.

Abstract
Importance:

A reduced incidence of microvascular invasion (MVI) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) may be associated with a decreased risk of early tumor recurrence and better survival after partial hepatectomy.
Objective:

To examine the association of preoperative antiviral treatment (AVT) with the incidences of MVI and posthepatectomy early tumor recurrence in HBV-related HCC.
Design, Setting, and Participants:

Data on a cohort of 2362 patients who underwent R0 resection for HBV-related HCC between January 2008 and April 2010 at the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China, were reviewed. The median (interquartile range) postoperative follow-up was 44.8 (22.8-59.3) months. Data were analyzed from June 2016 to October 2017.
Interventions:

Preoperative AVT and partial hepatectomy.
Main Outcomes and Measures:

Overall survival and time to recurrence after surgery were calculated and compared using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Independent risk factors of MVI presence were assessed by logistic regression analysis.
Results:

Among 2362 included patients, 1999 (84.6%) were men, and the median (interquartile range) age was 50.6 (43.1-57.3) years. A total of 2036 patients (86.2%) did not receive any preoperative AVT, while 326 (13.8%) received ongoing AVT more than 90 days before surgery. In the non-AVT group, compared with a preoperative HBV DNA level of less than 2000 IU/mL, a preoperative HBV DNA level of 2000 IU/mL or greater was associated with an increased risk of MVI (odds ratio [OR], 1.399; 95% CI, 1.151-1.701). Compared with the non-AVT group, patients receiving AVT had a lower incidence of MVI (38.7% [126 of 326] vs 48.6% [989 of 2036]; P = .001) and reduced risk of MVI (OR, 0.758; 95% CI, 0.575-0.998). A complete response to AVT was an independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952). Accordingly, preoperative AVT was associated with decreased 6-month, 1-year, and 2-year recurrences vs non-AVT (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P < .001); AVT was protective of early tumor recurrence (hazard ratio, 0.732; 95% CI, 0.605-0.886). In addition, patients in the non-AVT group were more likely to have multiple intrahepatic recurrences (49.1% [549 of 1119] vs 36.2% [54 of 149]; P = .003) and recurrences involving multiple hepatic segments compared with patients receiving AVT.
Conclusions and Relevance:

A high preoperative HBV DNA level was an independent risk factor of MVI. Antiviral treatment administered more than 90 days before surgery was associated with reduced incidences of MVI and early tumor recurrence after partial hepatectomy for HBV-related HCC.

PMID:
    30073257
DOI:
    10.1001/jamasurg.2018.2721

StephenW

JAMA Surg。 2018年8月1日：e182721。 doi：10.1001 / jamasurg.2018.2721。 [提前打印]
乙型肝炎病毒相关性肝细胞癌术前抗病毒治疗与微血管侵犯和早期肿瘤复发的关系。
Li Z1，Lei Z1，Xia Y1，Li J1，Wang K1，Zhang H1，Wan X1，Yang T1，Zhou W1，Wu M1，Pawlik TM2，Lau WY3，Shen F1。
作者信息

1
    第二军医大学东方肝胆外科医院肝外科，上海
2
    俄亥俄州立大学韦克斯纳医学中心外科，哥伦布。
3
    香港中文大学医学院，中国香港沙田。

抽象
重要性：

乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）中微血管侵犯（MVI）的发生率降低可能与早期肿瘤复发的风险降低和部分肝切除术后更好的存活率相关。
目的：

检查术前抗病毒治疗（AVT）与MVI和肝切除术后HBV相关性HCC早期肿瘤复发的关系。
设计，设置和参与者：

对2008年1月至2010年4月在中​​国上海第二军医大学东方肝胆外科医院接受HBV相关性HCC R0切除的2362例患者进行了回顾性分析。术后随访的中位数（四分位数间距）为44.8（22.8-59.3）个月。 2016年6月至2017年10月对数据进行了分析。
干预：

术前AVT和部分肝切除术。
主要成果和措施：

计算手术后的总体存活率和复发时间，并使用Kaplan-Meier方法，对数秩检验和Cox回归分析进行比较。通过逻辑回归分析评估MVI存在的独立危险因素。
结果：

在2362名纳入患者中，1999年（84.6％）为男性，中位数（四分位距）年龄为50.6（43.1-57.3）岁。共有2036名患者（86.2％）未接受任何术前AVT，而326名（13.8％）在手术前90天内接受了持续AVT。在非AVT组中，与术前HBV DNA水平低于2000 IU / mL相比，术前HBV DNA水平为2000 IU / mL或更高与MVI风险增加相关（优势比[OR]，1.399 ; 95％CI，1.151-1.701）。与非AVT组相比，接受AVT的患者MVI发生率较低（38.7％[126例中126例]，而48.6％[2036例中989例]; P = .001）且MVI风险降低（OR，0.758; 95 ％CI，0.575-0.998）。对AVT的完全反应是MVI的独立保护因子（OR，0.690; 95％CI，0.500-0.952）。因此，与非AVT相比，术前AVT与6个月，1年和2年复发相关（分别为14.2％，24.6％和38.5％，而23.4％，37.1％和52.3％; P <0.001）; AVT保护早期肿瘤复发（风险比，0.732; 95％CI，0.605-0.886）。此外，非AVT组患者更容易发生多次肝内复发（49.1％[1119]中的549例，而36.2％[149例中的54例]; P = .003）和多发性肝段复发相比接受治疗的患者AVT。
结论和相关性：

术前HBV DNA水平高是MVI的独立危险因素。手术前90天以上进行的抗病毒治疗与HBV相关性HCC部分肝切除术后MVI发生率降低和早期肿瘤复发有关。

结论：
    30073257
DOI：
    10.1001 / jamasurg.2018.2721