抗病毒治疗核苷酸类似物对HBV相关小肝细胞癌患者生存的影

StephenW

Cancer Manag Res. 2019 Sep 17;11:8475-8486. doi: 10.2147/CMAR.S201744. eCollection 2019.
Impact of antiviral therapy with nucleos(t)ide analog on survival of patients with HBV-related small hepatocellular carcinomas.
Wei Y#1,2, Yi Y#3, Tao C1,3, Ye W1,3, Zhao W1,3.
Author information

1
    Department of Infectious Diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China.
2
    Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
3
    Department of Hepatobiliary Surgeon, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.
#
    Contributed equally

Abstract
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.

© 2019 Wei et al.
KEYWORDS:

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

PMID:
    31572002
PMCID:
    PMC6756155
DOI:
    10.2147/CMAR.S201744

StephenW

癌症经理水库。 2019年9月17日; 11：8475-8486。 Doi：10.2147 / CMAR.S201744。 eCollection 2019。
抗病毒治疗核苷酸类似物对HBV相关小肝细胞癌患者生存的影响。
魏Y＃1，2，伊Y＃3，陶C1，3，叶W1，3，赵W1，3。
作者信息

1个
南京中医药大学南京第二医院传染病科，江苏南京。
2
安徽医科大学附属第一医院感染科，安徽合肥
3
南京中医药大学南京第二医院肝胆外科，中华人民共和国南京。
＃
平均贡献

抽象
背景：

肝细胞癌（HCC）是癌症相关死亡的第二大主要原因。肝癌通常基于慢性肝病，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：

这项研究的目的是评估使用核苷酸类似物（NA）对HBV相关小肝细胞癌（HBV-SHCC）患者预后的影响。
方法：

在这项回顾性研究中，NA经验组中有134例在SHCC诊断之前接受了长期NA治疗的患者，而43例在SHCC诊断后接受了NA治疗的患者为NA初始治疗组。未接受NA治疗的患者未接受NA治疗。在这些患者中，有些患者接受了手术切除，而其他一些局部复发的患者则接受了经皮动脉化疗栓塞（TACE），TACE透皮微波凝固疗法或仅采用TACE。使用Kaplan-Meier和Cox比例风险模型计算生存分析。
结果：

数据显示，NA经验组HBV-SHCC的1年，3年和5年总生存率分别为90.27％，90.69％和65％。仅NA组为70.81％，73.95％，47.39％，未治疗组。它们分别是54.96％，40.44％和47.39％（对数等级，P = 0.031）。阿德福韦酯（ADV）或LAM + ADV治疗的HBV-SHCC患者中位生存时间最长。在病毒破裂或无反应后未接受急救治疗的患者比在病毒破裂或无反应后接受急救治疗的患者具有更长的生存时间。与及时进行抢救治疗相比，病毒突破（危险比= 3.624，95％CI，1.035-12.687，P = 0.044）是具有Cox比例危险模型的HBV-SHCC患者的独立危险因素。对于有资格接受NA治疗的患者，即使确诊了HBV-SHCC，也应开始NA治疗。此外，即使HBV-SHCC的肝功能正常，也应接受及时的抢救治疗。
结论：

如果使用低抗性屏障药物治疗的SHCC患者具有病毒学应答，则不得改变治疗方案。

©2019 Wei等。
关键字：

慢性乙型肝炎肝细胞癌；肝硬化核苷类似物；及时抢救治疗；病毒突破

PMID：
31572002
PMCID：
PMC6756155
DOI：
10.2147 / CMAR.S201744

StephenW

https://www.dovepress.com/impact ... viewed-article-CMAR