乙型肝炎病毒相关肝细胞癌患者血清HBV DNA水平检测不到的临

StephenW

乙型肝炎病毒相关肝细胞癌患者血清HBV DNA水平检测不到的临床结果
Jong-In Chang 1，Dong Hyun Sinn 2，Hyun Cho 3，Seonwoo Kim 4，Wonseok Kang 1，Geum-Youn Gwak 1，Yong-Han Paik 1，Moon Seok Choi 1，Joon Hyeok Lee 1，Kwang Cheol Koh 1， Seung Woon Paik 1
隶属关系
隶属关系

    1
    韩国首尔江南区 Irwon-ro 81, Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Medicine, 06351, Korea。
    2
    韩国首尔江南区 Irwon-ro 81, Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Medicine, 06351, Korea。 [email protected]。
    3
    韩国首尔未来医学研究所三星医疗中心。
    4
    韩国首尔三星医疗中心统计和数据中心。

    PMID：34800218 DOI：10.1007/s10620-021-07312-8

抽象的

背景和目的：一些乙型肝炎病毒 (HBV) 相关的肝细胞癌 (HCC) 患者在 HCC 诊断时显示无法检测到的血清 HBV DNA 水平。 HBV 再激活的风险及其对临床结果的影响尚不清楚。

方法：这项回顾性队列研究共纳入了 985 名 HBV 相关 HCC 患者，在 HCC 诊断时血清 HBV DNA 水平检测不到（< 12 IU/mL）（112 名未接受抗病毒治疗（AVT）；873 名接受 AVT）。评估了随访期间 HBV 再激活（重新检测血清中的 HBV DNA）的发生率和危险因素，以及其与总生存期的关联。

结果：在平均 33.4 个月的随访期间（范围：0.2-124.2 个月），在 279 名患者中观察到 HBV 再激活。接受 AVT 的患者的 HBV 再激活率显着低于未接受 AVT 的患者（三年累积发生率：27.3% 对 56.0%；P < 0.001）。在多变量调整分析中，与未接受 AVT 的患者相比，接受 AVT 的患者 HBV 再激活的风险较低（调整后的风险比：0.39，95% 置信区间：0.29-0.54）。经历 HBV 再激活的患者的总体生存率显着低于未再激活的患者（5 年时分别为 71.5% 和 85.7%），并且与更高的总体死亡率风险相关（调整后的风险比：5.15，95% 置信区间：3.60-7.38） ）。

结论：超过一半的 AVT 初治患者在三年内经历了 HBV 再激活，这与总体死亡风险增加有关。接受 AVT 的患者 HBV 再激活的风险较低，这表明对于未检测到 HBV DNA 水平的 AVT 初治 HBV 相关 HCC 患者，需要考虑立即 AVT。

关键词：抗病毒治疗； HBV 爆发；乙型肝炎病毒;肝细胞癌。

© 2021。作者获得 Springer Science+Business Media, LLC 的独家许可，Springer Nature 的一部分。

StephenW

Clinical Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma Patients with Undetectable Serum HBV DNA Levels
Jong-In Chang  1 , Dong Hyun Sinn  2 , Hyun Cho  3 , Seonwoo Kim  4 , Wonseok Kang  1 , Geum-Youn Gwak  1 , Yong-Han Paik  1 , Moon Seok Choi  1 , Joon Hyeok Lee  1 , Kwang Cheol Koh  1 , Seung Woon Paik  1
Affiliations
Affiliations

    1
    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
    2
    Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. [email protected].
    3
    Samsung Medical Center, Research Institute for Future Medicine, Seoul, Korea.
    4
    Statistics and Data Center, Samsung Medical Center, Seoul, Korea.

    PMID: 34800218 DOI: 10.1007/s10620-021-07312-8

Abstract

Background and aims: Some hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients show undetectable serum HBV DNA levels at HCC diagnosis. The risk of HBV reactivation and its impact on clinical outcomes are not well-unknown.

Methods: This retrospective cohort study included a total of 985 HBV-related HCC patients with undetectable serum HBV DNA levels (< 12 IU/mL) at HCC diagnosis (112 were antiviral treatment (AVT)-naïve; 873 were receiving AVT). Incidence and risk factors for HBV reactivation (re-detection of HBV DNA in serum) during follow-up, as well as its association to overall survival, were assessed.

Results: During a median of 33.4 months of follow-up (range: 0.2-124.2 months), HBV reactivation was observed in 279 patients. HBV reactivation rate was significantly lower for patients receiving AVT than AVT-naïve patients (three-year cumulative incidence rate: 27.3% versus 56.0%; P < 0.001). In multivariable-adjusted analysis, the risk of HBV reactivation was lower for those receiving AVT compared to AVT-naïve patients (adjusted hazard ratio: 0.39, 95% confidence interval: 0.29-0.54). Overall survival was significantly lower for those experiencing HBV reactivation than those who did not (71.5% and 85.7% at five-year) and was associated with higher risk of overall mortality (adjusted hazard ratio: 5.15, 95% confidence interval: 3.60-7.38).

Conclusion: More than half of AVT-naïve patients experienced HBV reactivation within three years, which was associated with increased risk of overall mortality. The risk of HBV reactivation was lower for those receiving AVT, suggesting that prompt AVT needs to be considered for AVT naïve HBV-related HCC patients with undetectable HBV DNA levels.

Keywords: Antiviral therapy; HBV flare; Hepatitis B virus; Hepatocellular carcinoma.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature