抗病毒治疗可降低患有低水平乙型肝炎病毒血症的肝细胞癌

StephenW

抗病毒治疗可降低患有低水平乙型肝炎病毒血症的肝细胞癌患者的死亡率
王新会1、刘晓丽1、王鹏1、于丽华1、颜凤娜1、颜慧文1、周冬冬1、杨志云1
隶属关系
联系

    1
    首都医科大学附属北京地坛医院中西医结合中心，北京，100015。

    PMID：34708007 PMCID：PMC8544274 DOI：10.2147/JHC.S330301

抽象的

背景和目的：虽然抗病毒治疗已被证明可以降低乙型肝炎病毒 (HBV) 相关肝细胞癌 (HCC) 高 HBV-DNA 水平患者的死亡率，但尚不清楚它是否有助于降低低水平乙型肝炎病毒 (HBV) 相关肝细胞癌 (HCC) 患者的死亡率。 HBV-DNA 水平。

方法：回顾性分析北京地坛医院 2008 年 1 月至 2017 年 6 月 756 例 HBV-DNA < 500 IU/mL 的 HBV 相关 HCC 患者。首次在我院确诊为 HCC 时接受了核苷（酸）类似物（NA）治疗。我们使用年龄、性别、肿瘤大小、巴塞罗那临床肝癌 (BCLC) 分期、抗肿瘤治疗、肝硬化、糖尿病和高脂血症的 1:4 频率匹配来比较抗病毒药物 (n = 366) 和非抗病毒药物 (n = 100) 组。采用 Cox 多元回归分析评估 NA 治疗对风险比 (HR) 的影响，并使用 Kaplan-Meier 生存曲线确定 HCC 患者的死亡风险。进行对数秩检验以分析 NA 治疗对 HCC 患者存活率的影响。

结果：倾向评分匹配后，抗病毒和非抗病毒组的 1、3 和 5 年总生存率 (OS) 分别为 82.5%、68.6% 和 52.2%，以及 61.0%、51.0%、和 38.0%，分别。两组的 l 年无进展生存 (PFS) 率分别为 68.0% 和 47.0%。抗病毒组的 OS 显着高于对照组（分别为 P < 0.001、P = 0.001 和 P = 0.013）。抗病毒组的 1 年 PFS 也显着优于非抗病毒组（P = 0.005）。调整 Cox 模型中混杂的预后因素后，抗病毒治疗后 5 年死亡的 HR 为 0.721（95% 置信区间 [CI]，0.530-0.980，P = 0.037）。抗病毒治疗是 HCC 和低水平病毒血症患者 5 年死亡率的独立保护因素。

结论：抗病毒治疗显着降低了低 HBV-DNA 水平的 HCC 患者的死亡率。

关键词：抗病毒治疗；乙型肝炎病毒;肝细胞癌;低水平病毒血症；核苷（酸）类似物；预测。

© 2021 王等人。

StephenW

Antiviral Therapy Reduces Mortality in Hepatocellular Carcinoma Patients with Low-Level Hepatitis B Viremia
Xinhui Wang  1 , Xiaoli Liu  1 , Peng Wang  1 , Lihua Yu  1 , Fengna Yan  1 , Huiwen Yan  1 , Dongdong Zhou  1 , Zhiyun Yang  1
Affiliations
Affiliation

    1
    Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.

    PMID: 34708007 PMCID: PMC8544274 DOI: 10.2147/JHC.S330301

Abstract

Background and aims: Although antiviral treatment has been shown to reduce mortality in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients with high HBV-DNA levels, it is still unclear whether it is useful in reducing mortality in patients with low HBV-DNA levels.

Methods: A retrospective analysis of 756 HBV-associated HCC patients at the Beijing Ditan Hospital with HBV-DNA levels < 500 IU/mL was conducted between January 2008 and June 2017. Patients were divided into antiviral and non-antiviral groups based on whether they received nucleos(t)ide analogue (NA) treatment when they were diagnosed with HCC in our hospital for the first time. We used 1:4 frequency matching by age, gender, tumor size, Barcelona Clinic Liver Cancer (BCLC) staging, anti-tumor therapy, cirrhosis, diabetes, and hyperlipoidemia to compare the antiviral (n = 366) and non-antiviral (n = 100) groups. A Cox multivariate regression analysis was employed to evaluate the effects of NA therapy on the hazard ratio (HR), and the Kaplan-Meier survival curve was used to determine the mortality risk in patients with HCC. A Log rank test was performed to analyze the effects of NA therapy on the survival rate of patients with HCC.

Results: After propensity score matching, the 1-, 3-, and 5-year overall survival (OS) rates for the antiviral and non-antiviral groups were 82.5%, 68.6%, and 52.2%, and 61.0%, 51.0%, and 38.0%, respectively. The l-year progression-free survival (PFS) rates for the two groups were 68.0% and 47.0%, respectively. The OS of the antiviral group was significantly higher than that of the control group (P < 0.001, P = 0.001, and P = 0.013, respectively). The 1-year PFS for the antiviral group was also significantly better than that for the non-antiviral groups (P = 0.005). After adjusting for confounding prognostic factors in the Cox model, the HR of 5-year death after antiviral treatment was 0.721 (95% confidence interval [CI], 0.530-0.980, P = 0.037). Antiviral therapy is an independent protective factor for 5-year mortality in patients with HCC and low-level viremia.

Conclusion: Antiviral therapy significantly reduced mortality in HCC patients with low HBV-DNA levels.

Keywords: antiviral therapy; hepatitis B virus; hepatocellular carcinoma; low-level viremia; nucleos(t)ide analog; prognosis.

© 2021 Wang et al.

StephenW

https://www.dovepress.com/getfile.php?fileID=75127