核苷（酸）类似物抗病毒治疗对HBV相关小肝癌患者生存的影

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Impact of antiviral therapy with nucleos(t)ide analog on survival of patients with HBV-related small hepatocellular carcinomas
         

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Authors Wei Y, Yi Y, Tao C, Ye W, Zhao W

Received 16 January 2019

Accepted for publication 5 August 2019

Published 17 September 2019 Volume 2019:11 Pages 8475—8486

DOI https://doi.org/10.2147/CMAR.S201744

Checked for plagiarism Yes

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Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 3

Editor who approved publication: Dr Antonella D'Anneo

Yanyan Wei,1,2,* Yongxiang Yi,3,* Chen Tao,1,3 Wei Ye,1,3 Wei Zhao1,3

1Department of Infectious Diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 2Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 3Department of Hepatobiliary Surgeon, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wei Ye; Wei Zhao
Department of Infectious Diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1-1 Zhongfu Road, Nanjing, Jiangsu, People’s Republic of China
Email [email protected]; [email protected]

Background: Hepatocellular carcinoma (HCC) is the second leading causes of cancer-related death. HCC is usually based on chronic liver disease, mainly including chronic hepatitis C virus infection or chronic hepatitis B virus (HBV) infection.
Objective: The objective of the study was to evaluate the impact of the nucleos(t)ide analog (NA) use on the prognosis of patients with HBV-related small hepatocellular carcinomas (HBV-SHCC).
Methods: In this retrospective study, there were 134 patients who had been treated with long-term NA before SHCC diagnosis as NA-experienced group, 43 patients received NA-naïve treatment after SHCC diagnosis as NA-naïve group, and 15 patients who did not receive NA treatment as untreated group. Among these patients, some patients underwent surgical resection and others with local recurrence were treated with transarterial chemoembolization (TACE), TACE-percutaneous microwave coagulation therapy or TACE alone. The Kaplan–Meier and Cox-proportional hazard model were used to calculate the survival analysis.
Results: The data showed that 1-year, 3-year, 5-year overall survival rate of HBV-SHCC patients in NA-experienced group were 90.27%, 90.69%, 65%, NA-naïve group were 70.81%, 73.95%, 47.39%, and untreated group were 54.96%, 40.44%, 47.39%, respectively (Log-rank, P=0.031). The median survival time of HBV-SHCC patients treated with adefovir dipivoxil (ADV) or LAM+ADV has the longest survival time. Patients who have received rescue treatment after viral breakthrough or gotten maintained viral response had longer survival times than those who have not received rescue treatment after viral breakthrough or non-response. Compared with timely rescue treatment, viral breakthrough (hazard ratio=3.624, 95% CI, 1.035–12.687, P=0.044) was an independent risk factor for HBV-SHCC patients with Cox-proportional hazard model. For these patients conforming to NA-treatment indications, commencement of NA treatment should be given even after HBV-SHCC diagnosis. Moreover, HBV-SHCC patients who were suffering from virus break through should be treated timely rescue therapy even if their liver function was normal.
Conclusion: SHCC patients treated with low drug resistance barrier drugs may not change the treatment regimen if they have gotten virological response.

Keywords: chronic hepatitis B, hepatocellular carcinoma, liver cirrhosis, nucleos(t)ide analog, virus breakthrough, timely rescue therapy

StephenW

核苷（酸）类似物抗病毒治疗对HBV相关小肝癌患者生存的影响


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作者Wei Y，Yi Y，Tao C，Ye W，Zhao W

2019年1月16日收到

已接受发布于2019年8月5日

2019年9月17日出版卷2019：11页8475-8486

DOI https://doi.org/10.2147/CMAR.S201744

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批准出版的编辑：Antonella D'Anneo博士

Yanyan Wei，1,2，* Yongxiang Yi，3，*陈涛，1,3 Wei Ye，1,3 Wei Zhao 1,3

南京中医药大学南京第二医院感染科，南京，中华人民共和国; 2安徽医科大学第一附属医院感染科，中华人民共和国合肥;南京中医药大学南京第二医院肝胆外科，南京，中华人民共和国

*这些作者同等贡献这项工作

通讯：魏烨;赵薇
中华人民共和国南京中医药大学南京中医药大学第二医院感染科，中华民国南京市中孚路1-1号
电子邮件[email protected]; [email protected]

背景：肝细胞癌（HCC）是癌症相关死亡的第二大主要原因。 HCC通常基于慢性肝病，主要包括慢性丙型肝炎病毒感染或慢性乙型肝炎病毒（HBV）感染。
目的：本研究的目的是评估核苷（酸）类似物（NA）对HBV相关性小肝癌（HBV-SHCC）患者预后的影响。
方法：在这项回顾性研究中，有134名患者在SHCC诊断前接受长期NA治疗，为NA经验组，43名患者在SHCC诊断后接受NA-naïve治疗为NA-naïve组，15名患者接受NA治疗。未接受NA治疗作为未治疗组。在这些患者中，一些患者接受了手术切除，另一些患者局部复发，采用经动脉化疗栓塞（TACE），TACE-经皮微波凝固治疗或单独TACE治疗。 Kaplan-Meier和Cox比例风险模型用于计算生存分析。
结果：数据显示，NA经验组的HBV-SHCC患者1年，3年，5年总生存率分别为90.27％，90.69％，65％，NA-naïve组为70.81％，73.95％ ，47.39％，未治疗组分别为54.96％，40.44％，47.39％（Log-rank，P = 0.031）。用阿德福韦酯（ADV）或LAM + ADV治疗的HBV-SHCC患者的中位存活时间具有最长的存活时间。在病毒突破或维持病毒应答后接受抢救治疗的患者比病毒突破或无应答后未恢复抢救治疗的患者存活时间更长。与气象救援治疗相比，病毒突破（风险比= 3.624,95％CI，1.035-12.687，P = 0.044）是具有Cox比例风险模型的HBV-SHCC患者的独立危险因素。对于符合NA治疗适应症的这些患者，即使在HBV-SHCC诊断后也应开始NA治疗。此外，即使肝功能正常，也应在救治治疗期间治疗病毒突破的HBV-SHCC患者。
结论：低耐药性障碍药物治疗的SHCC患者如果得到病毒学应答，可能不会改变治疗方案。

关键词：慢性乙型肝炎，肝细胞癌，肝硬化，核苷酸类似物，病毒突破，气象拯救疗法

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