乙型肝炎肝硬化患者的抗病毒治疗和肝细胞癌风险

StephenW

Antiviral therapy and hepatocellular carcinoma risk in hepatitis B patients with cirrhosis

Gao, Xuesonga,,b; Yang, Hwai-Ic; Trinh, Huyd; Jeong, Donghaka; Li, Jiayie; Zhang, Jianf; Le, Ana; Hoang, Josepha; Nguyen, Paulinea; Henry, Lindaa; Nguyen, Mindie H.aAuthor Information

aDivision of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA

bDepartment of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing

cGenomics Research Center, Academia Sinica, Taipei, Taiwan, Republic of China

dSan Jose Gastroenterology, San Jose

eGastroenterology Department, Palo Alto Medical Foundation, Mountain View

fPrimary Care, Chinese Hospital, San Francisco, California, USA

Received 19 June 2019 Accepted 22 August 2019

Correspondence to Mindie H. Nguyen, MD, MAS, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304, USA, Tel: +650 498 5691; fax: +650 498 5692; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: September 2020 - Volume 32 - Issue 9 - p 1207-1211
doi: 10.1097/MEG.0000000000001639

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Abstract
Objectives:

Our goal was to evaluate the effect of antiviral therapy on hepatocellular carcinoma incidence for cirrhotic patients with lower hepatitis B virus DNA levels.
Methods:

Consecutive cirrhosis patients from a US cohort (n = 381) and 408 patients from a Taiwan cohort were enrolled. Patients were classified into a low (<20 IU/ml) and high hepatitis B virus DNA group (≥20 IU/ml), and each was further stratified into treated and untreated subgroups.
Results:

Except for hepatitis B e antigen, baseline characteristics were similar for both hepatitis B virus DNA groups. Antiviral therapy significantly reduced hepatocellular carcinoma incidence in cirrhotic patients with hepatitis B virus DNA ≥20 IU/ml at 5-years (12.2% vs. 22.8%) and 10-years (23.3% vs. 37.2%) (P = 0.0018). For cirrhotic patients with hepatitis B virus DNA <20 IU/ml, there was no statistically significant difference in cumulative hepatocellular carcinoma incidence between the treated and untreated groups. After adjusting for age, sex, and hepatitis B e antigen status, antiviral therapy was an independent predictor (hazard ratio 0.43, P < 0.0001) for reduced hepatocellular carcinoma risk in patients with hepatitis B virus DNA ≥20 IU/ml.
Conclusion:

Antiviral therapy was associated with a 57% reduction in hepatocellular carcinoma incidence in chronic hepatitis B patients with cirrhosis and hepatitis B virus DNA as low as 20 IU/ml (but no lower). However, hepatocellular carcinoma incidence remained substantial, regardless of hepatitis B virus DNA levels and treatment status, highlighting the need for ongoing hepatocellular carcinoma surveillance for all cirrhotic hepatitis B virus patients.

StephenW

乙型肝炎肝硬化患者的抗病毒治疗和肝细胞癌风险

高雪松，b；杨怀一；特琳，惠德；郑东卡李佳y张建夫安娜黄，约瑟夫； Paulinea阮；亨利，琳达； Nguyen，Mindie H.作者信息

美国加利福尼亚州斯坦福市斯坦福大学医学中心胃肠病和肝病科

b首都医科大学附属北京地坛医院普通科

中国台湾省中央研究院cGenomics研究中心

d圣何塞胃肠病学，圣何塞

帕洛阿尔托医学基金会电子胃肠病学系，山景城

f美国加利福尼亚州旧金山中国医院初级保健

2019年6月19日收到2019年8月22日接受

美国斯坦福大学医学中心胃肠病学和肝病学分部Mindie H. Nguyen博士，美国加利福尼亚州94304，帕洛阿尔托，韦尔奇路750号210室，电话：+650 498 5691；传真：+650 498 5692;电子邮件：[email protected]
《欧洲胃肠病学和肝病学杂志》：2020年9月-第32卷-第9期-第1207-1211页
doi：10.1097 / MEG.0000000000001639

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抽象
目标：

我们的目标是评估抗病毒治疗对乙型肝炎病毒DNA水平较低的肝硬化患者的肝细胞癌发生率的影响。
方法：

美国队列（n = 381）的连续性肝硬化患者和台湾队列的408例患者入组。将患者分为低（<20 IU / ml）和高乙型肝炎病毒DNA组（≥20IU / ml），然后将患者进一步分为治疗组和未治疗组。
结果：

除乙肝e抗原外，两个乙肝病毒DNA组的基线特征均相似。抗病毒治疗显着降低了乙肝病毒DNA≥20 IU / ml的肝硬化患者在5年（12.2％对22.8％）和10年（23.3％对37.2％）时的肝细胞癌发生率（P = 0.0018）。对于乙型肝炎病毒DNA <20 IU / ml的肝硬化患者，治疗组和未治疗组之间累积肝细胞癌发生率无统计学差异。在调整了年龄，性别和乙肝e抗原状态后，抗病毒治疗是降低乙肝病毒DNA≥20 IU / ml的肝细胞癌风险的独立预测因子（危险比0.43，P <0.0001）。
结论：

在慢性乙型肝炎肝硬化和乙型肝炎病毒DNA低至20 IU / ml（但不更低）的患者中，抗病毒治疗可使肝细胞癌的发生率降低57％。但是，无论乙肝病毒DNA的水平和治疗状况如何，肝细胞癌的发生率仍然很高，这凸显了对所有肝硬化乙肝病毒患者进行持续肝细胞癌监测的必要性。

健康平安猫

谢谢分享！
乙型肝炎病毒DNA <20 IU / ml的肝硬化患者，5年和10年的肝癌发生率有吗？

病毒DNA <20 IU 的话，治疗与否都区别不大，是这样理解的吗？

StephenW

回复 健康平安猫 的帖子

抱歉，看不到完整的论文, 看不到发生率.

病毒DNA <20 IU 的话，治疗与否都区别不大，是这样理解的吗？  符合,符合论文结论.

健康平安猫

回复 StephenW 的帖子

谢谢解答!