核苷酸类似物治疗手术切除的乙型肝炎病毒相关肝细胞癌的

StephenW

Early and late recurrence of surgically resected hepatitis B virus-related hepatocellular carcinoma on nucleos(t)ide analogues therapy
Chi-Jung Wu  1 , Gar-Yang Chau  2 , I-Cheng Lee  3 , Teh-Ia Huo  4 , Chien-Wei Su  3 , Ming-Chih Hou  3 , Yi-Hsiang Huang  5
Affiliations
Affiliations

    1
    Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
    2
    Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
    3
    Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
    4
    Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
    5
    Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: [email protected].

    PMID: 33334659 DOI: 10.1016/j.jfma.2020.11.019

Abstract

Background/purpose: Hepatocellular carcinoma (HCC) is a highly recurrent tumor. Antiviral therapy with nucleos(t)ide analogues (NUCs) may reduce the risk of recurrence in hepatitis B virus (HBV)-related HCC. The risk factors associated with recurrence in HCC patients after surgical resection and with NUCs treatment should be delineated.

Methods: Consecutive 339 HBV-related HCC patients receiving surgical resection of HCC with NUCs therapy (including 256 entecavir, 36 tenofovir, and 18 lamivudine) after the surgery were retrospectively reviewed. Factors related to the recurrence-free survival (RFS) and overall survival (OS) were evaluated.

Results: After a median of 48.5 months of follow-up, 183 (54%) patients developed HCC recurrence, with the 5-year RFS of 42.8% and OS of 79%. Male gender (HR = 1.736, p = 0.037), baseline HBsAg level >200 IU/ml (HR = 1.748, p = 0.008), platelet count ≦100 (109/L) (HR = 1.592, p = 0.023), presence of microscopic vascular invasion (MVI) (HR = 1.499, p = 0.026), safety cut margin of ≦0.5 cm (HR = 1.507, p = 0.013), and Ishak fibrosis score 5-6 (HR = 1.579, p = 0.009) were independent factors associated with RFS in multivariate analysis. While tumor burden, platelet count, MVI, and safety cut margin were factors associated with early recurrence; baseline HBsAg level, and platelet count were independent factors associated with late recurrence. Ishak fibrosis score 5-6, poor differentiation, MVI, diabetes mellitus were factors associated with OS in multivariate analysis.

Conclusions: For HBV-HCC patients on NUCs treatment, tumor factors are associated with early recurrence, while HBsAg level and thrombocytopenia determines late recurrence. For patient with a high baseline HBsAg level, warning of higher risk of recurrence is required even under NUCs treatment.

Keywords: Early recurrence; Hepatitis B surface antigen; Hepatocellular carcinoma; Late recurrence; Nucleos(t)ide analogues.

Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

StephenW

核苷酸类似物治疗手术切除的乙型肝炎病毒相关肝细胞癌的早期和晚期复发
吴志荣1，周嘉扬2，李一成3，霍德雅4，苏建伟3，侯明治3，黄以祥5
隶属关系
隶属关系

    1个
    台湾台北市台北荣民总医院消化内科及消化内科。
    2
    台湾台北市荣民总医院外科普外科。
    3
    台湾台北市荣民总医院消化内科国立阳明大学医学院医学院，台湾台北。
    4
    台湾台北市荣民总医院消化内科台湾台北市荣民总医院医学研究室;国立阳明大学医学院药理研究所，台湾台北。
    5
    台湾台北市荣民总医院消化内科国立阳明大学医学院医学院，台湾台北；国立阳明大学医学院临床医学院，台湾台北。电子地址：[email protected]。

    PMID：33334659 DOI：10.1016 / j.jfma.2020.11.019

抽象

背景/目的：肝细胞癌（HCC）是一种高度复发的肿瘤。核苷酸类似物（NUCs）的抗病毒治疗可降低与乙肝病毒（HBV）相关的HCC复发的风险。应当明确与手术切除后的HCC患者复发以及NUCs治疗相关的危险因素。

方法：回顾性分析339例接受NUCs治疗的肝癌手术切除的HBV相关性HCC患者（包括256例恩替卡韦，36例替诺福韦和18例拉米夫定）。评估与无复发生存期（RFS）和总生存期（OS）相关的因素。

结果：中位随访48.5个月后，有183例（54％）患者发生了HCC复发，其5年RFS为42.8％，OS为79％。男性（HR = 1.736，p = 0.037），基线HBsAg水平> 200 IU / ml（HR = 1.748，p = 0.008），血小板计数≦100（109 / L）（HR = 1.592，p = 0.023），存在显微血管侵犯（MVI）（HR = 1.499，p = 0.026），安全切缘≤0.5 cm（HR = 1.507，p = 0.013）和Ishak纤维化评分5-6（HR = 1.579，p = 0.009）是多因素分析中与RFS相关的独立因素。肿瘤负荷，血小板计数，MVI和安全性降低余量是与早期复发相关的因素；基线HBsAg水平和血小板计数是与晚期复发相关的独立因素。 Ishak纤维化评分5-6，分化差，MVI，糖尿病是多因素分析中与OS相关的因素。

结论：对于接受NUC治疗的HBV-HCC患者，肿瘤因素与早期复发相关，而HBsAg水平和血小板减少则决定了晚期复发。对于基线HBsAg水平较高的患者，即使在NUCs治疗下也需要警告更高的复发风险。

关键字：早期复发；乙型肝炎表面抗原；肝细胞癌；晚期复发；核苷类似物。

版权所有©2020福尔摩沙医学协会。由Elsevier B.V.发布。保留所有权利。

StephenW

https://www.sciencedirect.com/sc ... 20305969?via%3Dihub