抗病毒治疗可提高肝癌手术后的生存率

StephenW

抗病毒治疗可提高肝癌手术后的生存率

M. Alexander Otto，宾夕法尼亚州，彩信

2022 年 10 月 20 日
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本摘要中涵盖的研究已作为预印本发表在 researchsquare.com 上，尚未经过同行评审。
关键要点

    抗病毒治疗可提高乙型肝炎病毒 (HBV) 相关肝细胞癌 (HCC) 肝切除术后老年患者的生存率。

为什么这很重要

    HBV是导致HCC的主要原因。

    没有标准的辅助治疗来预防术后复发。

    一些研究表明，辅助抗病毒治疗可降低 HBV 相关肝癌患者的复发风险并提高生存率，但该问题尚未在 65 岁及以上的患者中进行调查。

    根据他们的发现，研究人员建议在老年患者的 HBV 相关疾病治愈性切除后进行辅助抗病毒治疗。

学习规划

    该团队回顾了中国肝癌数据库中的 300 名年龄在 65 岁或以上的患者，这些患者接受了 HCC 的 R0 切除术。

    患者乙型肝炎表面抗原检测呈阳性，丙型肝炎抗体呈阴性。

    总体而言，177 人在手术后接受了超过 3 个月的辅助抗病毒治疗； 123 没有。

    辅助抗病毒治疗包括拉米夫定 100 mg/d、阿德福韦 10 mg/d 和恩替卡韦 0.5 mg/d。

    倾向评分匹配用于控制患者选择中的偏倚。

主要结果

    倾向评分匹配后，辅助抗病毒治疗组的中位总生存期 (OS) 为 5.8 年，未治疗组为 3.9 年。

    辅助抗病毒治疗的中位无复发生存期为 3.1 年，没有辅助抗病毒治疗的中位无复发生存期为 2.2 年。

    辅助抗病毒治疗组的 1、3 和 5 年 OS 分别为 97.5%、76% 和 55%；未经抗病毒治疗，1、3 和 5 年的 OS 分别为 83.5%、60.1% 和 40.9%（差异 P = .003）。

    辅助抗病毒治疗的 1 年、3 年和 5 年无复发生存率分别为 76.6%、50.2% 和 30.4%；未经抗病毒治疗，1 年、3 年和 5 年无复发生存率分别为 63.2%、42.4% 和 26.6% (P = .120)。

    多变量分析显示术后抗病毒治疗可防止死亡（风险比，0.46；P < .001）。

限制

    这是一项仅限于中国患者的回顾性研究。

    结果与HBV基因型或特定抗病毒治疗药物的使用无关。

披露

    该研究得到了福建省医学创新项目等的资助。

    调查人员没有披露任何相关的财务关系。

这是一项预印本研究的总结，“老年 HCC 患者术后抗病毒治疗的疗效：一项回顾性多中心倾向评分匹配研究”，由福建医科大学孟超肝胆医院的张金宇领导，中国福州，并由 Medscape 提供给您。该研究尚未经过同行评审。全文可在 researchsquare.com 上找到。

M. Alexander Otto 是一名助理医师，拥有纽豪斯医学科学硕士学位和新闻学学位。他是一位屡获殊荣的医学记者，在加入 Medscape 之前曾为多家主要新闻媒体工作，同时也是 MIT Knight 科学新闻研究员。电子邮件：[email protected]。

StephenW

Antiviral Therapy Improves Survival After Liver Cancer Surgery

M. Alexander Otto, PA, MMS

October 20, 2022
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The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.
Key Takeaway

    Antiviral therapy improves survival among elderly patients after hepatectomy for hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC).

Why This Matters

    HBV is a major cause of HCC.

    There are no standard adjuvant treatments to prevent recurrence after surgery.

    Some studies have shown that adjuvant antiviral therapy reduces the risk of recurrence and improves survival for patients with HBV-related liver cancer, but the issue hasn't been investigated in patients aged 65 years and older.

    On the basis of their findings, the investigators recommend adjuvant antiviral therapy after curative resection of HBV-related disease in elderly patients.

Study Design

    The team reviewed 300 patients in a Chinese liver cancer database who were aged 65 years or older when they underwent R0 resections for HCC.

    Patients had tested positive for hepatitis B surface antigen and negative for hepatitis C antibody.

    Overall, 177 received adjuvant antiviral therapy for more than 3 months after surgery; 123 did not.

    Adjuvant antiviral therapies included lamivudine 100 mg/d, adefovir 10 mg/d, and entecavir 0.5 mg/d.

    Propensity score matching was used to control bias in patient selection.

Key Results

    After propensity score matching, the median overall survival (OS) was 5.8 years in the adjuvant antiviral therapy group and 3.9 years in the no-therapy group.

    Median recurrence-free survival was 3.1 years with adjuvant antiviral therapy and 2.2 years without it.

    In the adjuvant antiviral therapy group, OS at 1, 3, and 5 years was 97.5%, 76%, and 55%, respectively; without antiviral therapy, OS at 1, 3, and 5 years was 83.5%, 60.1%, and 40.9%, respectively (P for difference = .003).

    The 1-, 3-, and 5-year recurrence-free survival rates with adjuvant antiviral therapy were 76.6%, 50.2%, and 30.4%, respectively; without antiviral therapy, the 1-, 3-, and 5-year recurrence-free survival rates were 63.2%, 42.4%, and 26.6%, respectively (P = .120).

    Postoperative antiviral therapy protected against death on multivariate analysis (hazard ratio, 0.46; P < .001).

Limitations

    It was a retrospective study limited to patients in China.

    Results were not correlated with HBV genotype or use of specific antiviral therapy drugs.

Disclosures

    The study was funded by the Medical Innovation Project of Fujian Province and others.

    The investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "The Efficacy of Postoperative Antiviral Therapy in Elderly HCC Patients: A Retrospective Multicenter Propensity Score-Matched Study," led by Jinyu Zhang of the Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China, and provided to you by Medscape. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].