抗病毒治疗可减少HBV相关性肝癌后肝切除术后肿瘤复发

StephenW

Hannah Dellabella
August 30, 2018
Antiviral Treatment May Reduce Posthepatectomy Tumor Recurrence in HBV-Related HCC


A high preoperative HBV DNA level was an independent risk factor for microvascular invasion risk in HBV-related hepatocellular carcinoma. A high preoperative HBV DNA level was an independent risk factor for microvascular invasion risk in HBV-related hepatocellular carcinoma.

For patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), undergoing antiviral treatment (AVT) before a partial hepatectomy can decrease the risk for microvascular invasion (MVI) and posthepatectomy early tumor recurrence, according to results published in JAMA Surgery.

The results also indicated that a high preoperative HBV DNA level was an independent risk factor for MVI.

The study included data on a cohort of participants 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 (n=2362). The median postoperative follow-up period was 44.8 months. The researchers used the Kaplan-Meier method, log-rank test, and Cox regression analysis to calculate and compare overall survival and time to recurrence after surgery. They then used logistic regression analysis to assess independent risk factors of MVI presence.


In total, 86.2% (n=2036) of participants did not receive preoperative AVT, whereas 13.8% (n=326) received ongoing AVT more than 90 days before surgery.

Among participants who did not undergo AVT, preoperative HBV DNA levels ≥2000 IU/mL were associated with an increased risk for MVI compared with HBA DNA levels <2000 IU/mL (odds ratio [OR], 1.399; 95% CI, 1.151-1.701).

Participants receiving AVT had a lower incidence of MVI (38.7% [126 of 326]) compared with participants who did not receive AVT (48.6% [989 of 2036]; P =.001).

Participants receiving AVT also had a reduced risk for MVI (OR, 0.758; 95% CI, 0.575-0.998).

The researchers found that a complete response to AVT was an independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952).

The results indicated that preoperative AVT was associated with decreased 6-month, 1-year, and 2-year recurrences compared with patients not receiving AVT (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P <.001).

Participants who did not receive AVT were more likely to have multiple intrahepatic recurrences (49.1% [549 of 1119]) compared with participants who received AVT (36.2% [54 of 149]; P =.003).

"Since MVI is also closely associated with tumor recurrence after liver transplantation for HCC, whether pretransplant AVT affects the incidence of MVI in viral-related HCC should be further investigated," the researchers wrote.
Reference

Li Z, Lei Z, Xia Y, et al. Association of preoperative antiviral treatment with incidences of microvascular invasion and early tumor recurrence in hepatitis B virus-related hepatocellular carcinoma [published online August 1, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.2721

StephenW

汉娜德拉贝拉
2018年8月30日
抗病毒治疗可减少HBV相关性肝癌后肝切除术后肿瘤复发


术前HBV DNA水平高是HBV相关性肝细胞癌微血管侵犯风险的独立危险因素。术前HBV DNA水平高是HBV相关性肝细胞癌微血管侵犯风险的独立危险因素。

对于乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）患者，在部分肝切除术前接受抗病毒治疗（AVT）可以降低微血管侵犯（MVI）和肝切除术后早期肿瘤复发的风险，根据JAMA Surgery发表的结果。

结果还表明，术前高HBV DNA水平是MVI的独立危险因素。

该研究纳入了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HCC R0切除的一组参与者的数据（n = 2362）。术后随访时间中位数为44.8个月。研究人员使用Kaplan-Meier方法，对数秩检验和Cox回归分析来计算和比较手术后的总生存期和复发时间。然后，他们使用逻辑回归分析来评估MVI存在的独立危险因素。


总共有86.2％（n = 2036）的参与者没有接受术前AVT，而13.8％（n = 326）在手术前超过90天接受了持续的AVT。

在没有接受AVT的参与者中，术前HBV DNA水平≥2000IU/ mL与MVI风险增加相关，而HBA DNA水平<2000 IU / mL（优势比[OR]，1.399; 95％CI，1.151- 1.701）。

与未接受AVT的参与者相比，接受AVT的参与者发生MVI的发生率较低（38.7％[126个中的126个]）（48.6％[2036年的989]; P = .001）。

接受AVT的参与者的MVI风险也降低（OR，0.758; 95％CI，0.575-0.998）。

研究人员发现，对AVT的完全反应是MVI的独立保护因素（OR，0.690; 95％CI，0.500-0.952）。

结果显示，与未接受AVT的患者相比，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 <.001）。

与接受AVT的参与者相比，未接受AVT的参与者更有可能发生多次肝内复发（49.1％[1119]中的549例）（36.2％[54/149]; P = .003）。

“由于MVI也与HCC肝移植术后肿瘤复发密切相关，因此应进一步研究移植前AVT是否影响病毒相关性HCC中MVI的发生率，”研究人员写道。
参考

李,,雷泽，夏娅，等。术前抗病毒治疗与乙型肝炎病毒相关性肝细胞癌微血管侵犯和早期肿瘤复发的关联[在线发表于2018年8月1日]。 JAMA Surg。 doi：10.1001 / jamasurg.2018.2721