恩替卡韦联合干扰素-α在降低慢性乙型肝炎患者肝癌和肝外

StephenW

恩替卡韦联合干扰素-α在降低慢性乙型肝炎患者肝癌和肝外癌发生率方面优于恩替卡韦单药治疗
程开良1、陈宇2 3、王小沫1、徐曼曼2 3、伟廖1、段小曼4、赵新宇1、孙媛媛1、段中平2 3、王丽1
隶属关系
隶属关系

    1
    中国医学科学院基础医学研究所/北京协和医学院基础医学院流行病学与生物统计学系，北京，中国。
    2
    首都医科大学附属北京佑安医院肝病四科（疑难杂症肝病及人工肝中心）。
    3
    北京市肝衰竭与人工肝治疗研究重点实验室，北京，中国。
    4
    萨姆休斯顿州立大学，德克萨斯州亨茨维尔。

    PMID：34623636 DOI：10.1002/cncr.33949

抽象的

背景：本研究的目的是评估恩替卡韦 (ETV) 联合干扰素-α (IFN-α) 是否可以减少慢性乙型肝炎 (CHB) 患者的肝细胞癌 (HCC) 和肝外癌 (EHC)。

方法：该队列包括 2009 年 1 月至 2017 年 12 月在中国北京一家三级医院接受 ETV 联合 IFN-α 或 ETV 单药治疗的 4194 例 CHB 患者。比较两组的 HCC 和 EHC 的间隔 (CI)。

结果：在多变量 Cox 回归分析中，HCC 风险显着降低（HR，0.6；95% CI，0.3-0.9；P = .0310）和 EHC 风险略微显着降低（HR，0.2；95% CI， 0.02-1.3；P = .0854) 在接受 ETV 联合 IFN-α 的组中观察到与 ETV 单药治疗组相比。联合治疗组的年度病毒学应答率显着高于单药治疗组（33.8% 对 21.2%；P < .0001），但乙肝表面抗原 (HBsAg) 血清清除率却没有（1.2% 对 0.9%； P = .8537）。 HR 与基于倾向评分的匹配、逆概率加权调整以及病毒学反应和 HBsAg 血清清除率的调整一致。

结论：ETV联合IFN-α治疗在降低CHB患者发生HCC和EHCs的风险方面优于ETV单药治疗。可以耐受 IFN-α 治疗并从中受益的人可以考虑联合治疗。

关键词：恩替卡韦；肝外癌;肝细胞癌;干扰素；现实世界的研究。

© 2021 美国癌症协会。

StephenW

Entecavir combined with interferon-α is superior to entecavir monotherapy in reducing hepatic and extrahepatic cancer in patients with chronic hepatitis B
Kailiang Cheng  1 , Yu Chen  2   3 , Xiaomo Wang  1 , Manman Xu  2   3 , Wei Liao  1 , Xiaoman Duan  4 , Xinyu Zhao  1 , Yuanyuan Sun  1 , Zhongping Duan  2   3 , Li Wang  1
Affiliations
Affiliations

    1
    Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China.
    2
    Fourth Department of Liver Disease (Difficult and Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital, Capital Medical University, Beijing, China.
    3
    Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China.
    4
    Sam Houston State University, Huntsville, Texas.

    PMID: 34623636 DOI: 10.1002/cncr.33949

Abstract

Background: The objective of this study was to assess whether entecavir (ETV) in combination with interferon-α (IFN-α) could reduce hepatocellular cancer (HCC) and extrahepatic cancers (EHCs) in patients with chronic hepatitis B (CHB).

Methods: The cohort consisted of 4194 patients with CHB treated with ETV combined with IFN-α or ETV monotherapy at a tertiary hospital in Beijing, China, from January 2009 to December 2017. The risks, hazard ratios (HRs), and 95% confidence intervals (CIs) of HCC and EHCs were compared in the 2 groups.

Results: In a multivariate Cox regression analysis, a significantly lower risk of HCC (HR, 0.6; 95% CI, 0.3-0.9; P = .0310) and a marginally significantly lower risk of EHCs (HR, 0.2; 95% CI, 0.02-1.3; P = .0854) were observed in the group receiving ETV combined with IFN-α in comparison with the ETV monotherapy group. The annual virological response rates were significantly higher in the combination therapy group versus the monotherapy group (33.8% vs 21.2%; P < .0001), but the hepatitis B surface antigen (HBsAg) seroclearance rates were not (1.2% vs 0.9%; P = .8537). The HRs were consistent with propensity score-based matching, inverse probability weighting adjustments, and adjustments for virological response and HBsAg seroclearance.

Conclusions: ETV combined with IFN-α therapy is superior to ETV monotherapy in reducing the risk of HCC and EHCs for patients with CHB. People who can tolerate and benefit from IFN-α therapy could consider combination therapy.

Keywords: entecavir; extrahepatic cancers; hepatocellular carcinoma; interferon; real-world studies.

© 2021 American Cancer Society.