增加抗病毒治疗的摄取量可改善HBV相关HCC患者的生存率

StephenW

Increasing antiviral treatment uptake improves survival in patients with HBV-related HCC
Vicki Wing-Ki Hui  1   2   3 , Stephen Lam Chan  4 , Vincent Wai-Sun Wong  1   2   3 , Lilian Yan Liang  1 , Terry Cheuk-Fung Yip  1   2   3 , Jimmy Che-To Lai  1 , Becky Wing-Yan Yuen  1 , Hester Wing-Sum Luk  1 , Yee-Kit Tse  1   2   3 , Hye-Won Lee  5 , Henry Lik-Yuen Chan  1   2   3 , Grace Lai-Hung Wong  1   2   3
Affiliations
Affiliations

    1
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
    2
    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
    3
    Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
    4
    Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China.
    5
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

    PMID: 33024950 PMCID: PMC7530304 DOI: 10.1016/j.jhepr.2020.100152

Abstract

Background & aims: Antiviral treatment is known to improve survival in patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Yet, the treatment uptake in CHB patients remains low. We aimed to report the secular trend in antiviral treatment uptake from 2007-2017, and to compare the effect of different nucleos(t)ide analogue (NA) initiation times (before vs. after HCC diagnosis) on survival.

Methods: A 3-month landmark analysis was used to compare overall survival in patients not receiving NA treatment (i.e. no NA), patients receiving NAs after their first HCC treatment (i.e. post-HCC NA), and patients receiving NAs ≤3 months before their first HCC treatment (i.e. pre-HCC NA). A propensity score-weighted Cox proportional hazards model was used to balance clinical characteristics between the 3 groups and to estimate hazard ratios (HRs).

Results: The uptake of antiviral treatment in HCC patients increased from 47.3% in 2007 to 98.3% in 2017. The pre-HCC NA group contributed mostly to the uptake rate, which increased from 72.7% to 96.0% in the past decade. In addition, 3,843 CHB patients (407 no NA; 2,932 pre-HCC NA; 504 post-HCC NA) with HCC, receiving at least 1 type of HCC treatment, were included in the analysis. Lack of NA treatment at the time of HCC diagnosis increased the risk of death (weighted HR 3.05; 95% CI 2.70-3.44; p <0.001). The impact of the timing of NA treatment was insignificant (weighted HR 0.90; 95% CI 0.78-1.04; p = 0.161).

Conclusions: The uptake of antiviral treatment in HCC patients increased over the past decade. NA treatment, regardless of whether it was initiated before or after HCC diagnosis, improved survival. It is never too late to initiate NA treatment, even after HCC diagnosis.

Lay summary: More and more patients who have hepatitis B-related liver cancer received antiviral treatment over the past decade. The timing of starting antiviral treatment, regardless of whether it was before or after liver cancer happens, does not really matter in terms of survival benefits.

Keywords: AFP, alpha-fetoprotein; ALT, alanine aminotransferase; ASMD, absolute standardised mean difference; CDARS, Clinical Data Analysis and Reporting System; CHB, chronic hepatitis B; Entecavir; GGT, gamma-glutamyl transpeptidase; HCC, hepatocellular carcinoma; HR, hazard ratio; Hazard ratio; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; IPTW, inverse probability of treatment weighting; IQR, inter-quartile range; KS, Kolmogorov-Smirnov; Lamivudine; Local ablative therapy; MICE, multivariate imputation by chained equations; NA, nucleos(t)ide analogue; PS, propensity score; Propensity scores; Surgical resection; TACE, transarterial chemoembolisation; TDF, tenofovir disoproxil fumarate; Transarterial chemoembolisation; aHR, adjusted hazard ratio.

© 2020 The Author(s).

StephenW

增加抗病毒治疗的摄取量可改善HBV相关HCC患者的生存率
许永基1 2 3，林俊杰4，黄伟森1 2 3，李连彦梁1，卓德峰叶1 2 3，黎智贤1，袁咏仪1 2 ，陆永S 1，谢怡洁1 2 3，李慧媛5，亨利力媛1 2 3，黄丽红1 2 3
隶属关系
隶属关系

    1个
    香港中文大学，香港特别行政区医学与治疗学系。
    2
    中国香港特别行政区香港中文大学消化系统疾病研究所。
    3
    中国香港特别行政区香港中文大学医学数据分析中心。
    4
    香港中文大学，香港中文大学临床肿瘤学系。
    5
    延世大学医学院内科，韩国首尔。

    PMID：33024950 PMCID：PMC7530304 DOI：10.1016 / j.jhepr.2020.100152

抽象

背景与目的：已知抗病毒治疗可改善慢性乙型肝炎（CHB）相关性肝细胞癌（HCC）患者的生存率。但是，CHB患者的治疗吸收率仍然很低。我们旨在报告2007-2017年抗病毒治疗吸收的长期趋势，并比较不同核苷酸（t）核苷酸类似物（NA）起始时间（HCC诊断之前与之后）对生存的影响。

方法：使用3个月的地标分析比较未接受NA治疗的患者（即无NA），首次HCC治疗后接受NA的患者（即HCC后NA）和接受NA≤3个月的患者的总生存期他们的首次HCC治疗（即HCC之前的NA）。使用倾向得分加权的Cox比例风险模型来平衡3组之间的临床特征并估计风险比（HRs）。

结果：HCC患者接受抗病毒治疗的比例从2007年的47.3％增加到2017年的98.3％。HCC之前的NA组对摄取率的贡献最大，在过去十年中从72.7％增加到96.0％。此外，分析中包括了接受至少一种HCC治疗的3,843名CHB患者（407名无NA； 2,932名HCC之前的NA； 504名HCC后的NA）。在HCC诊断时缺乏NA治疗会增加死亡风险（加权HR 3.05； 95％CI 2.70-3.44； p <0.001）。 NA治疗时机的影响不明显（加权HR 0.90； 95％CI 0.78-1.04； p = 0.161）。

结论：在过去十年中，HCC患者接受抗病毒治疗的人数有所增加。无论是否在HCC诊断之前或之后开始进行NA治疗，均可改善生存率。即使在HCC诊断之后，开始进行NA治疗也永远不会太晚。

摘要：在过去的十年中，越来越多的乙型肝炎相关肝癌患者接受了抗病毒治疗。不管是在肝癌发生之前还是之后，开始抗病毒治疗的时机对于生存效益而言都并不重要。

关键词：AFP，甲胎蛋白； ALT，丙氨酸转氨酶； ASMD，绝对标准化均值差； CDARS，临床数据分析和报告系统； CHB，慢性乙型肝炎；恩替卡韦; GGT，γ-谷氨酰转肽酶； HCC，肝细胞癌；人力资源，危险比；危险几率; ICD-9-CM，国际疾病分类，第九次修订，临床修改； IPTW，治疗加权的逆概率； IQR，四分位间距； KS，Kolmogorov-Smirnov；拉米夫定;局部消融治疗； MICE，通过链式方程进行的多元估算； NA，核苷酸（t）化物类似物； PS，倾向得分；倾向得分；手术切除； TACE，经动脉化学栓塞； TDF，替诺福韦富马酸酯经动脉血栓栓塞； aHR，调整后的危险比。

©2020作者。

StephenW

https://www.jhep-reports.eu/arti ... 20)30086-0/fulltext