HCC 诊断时或之前的抗 HBV 治疗可提高生存率……

StephenW

HCC 诊断时或之前的抗 HBV 治疗可提高生存率……


….只有 37% 接受治疗，非亚洲人的治疗率较低


AASLD—肝脏会议，2022 年 11 月 4 日至 8 日，华盛顿特区

马克·马斯科里尼

在美国全国保险和处方索赔数据库中，在 HBV 相关肝细胞癌 (HCC) 诊断时或之前接受乙型肝炎病毒 (HBV) 感染的抗病毒治疗与提高人们的生存率独立相关 [1]。事实证明，女性、非亚洲人、没有专业护理的人以及其他一些群体不太可能接受抗 HBV 治疗。

研究将抗 HBV 治疗与 HBV 相关 HCC 的更好生存率联系起来，但进行这项研究的斯坦福大学研究人员指出，这项工作的大部分仅限于患者亚组或在三级医疗中心接受治疗的人。没有人知道这些重点研究的结果是否适用于患有 HCC 的普通人群。此外，斯坦福团队观察到，目前的慢性 HBV 指南并未针对 HCC 提出具体的抗病毒建议。

为了更广泛地了解抗病毒药物对 HBV 相关 HCC 患者的影响和影响，斯坦福大学的研究人员收集了美国常规实践中的真实世界 HCC 患者队列的数据。这些回顾性数据来自 Optum 临床信息数据库，其中包含 2003-2021 年的资格、医疗索赔和处方索赔数据 [2]。研究人员旨在估计 HBV 相关 HCC 患者服用抗病毒药物的频率和时间，寻找抗 HBV 药物使用的差异，并确定抗病毒药物对生存的影响。

研究人员使用 ICD-9-CM 或 ICD-10-CM 代码来寻找 18 岁或以上患有 HBV 相关 HCC 的人，以确定有多少人接受了抗 HBV 抗病毒治疗，比较接受抗病毒治疗和未经治疗的人的生存率，并通过多变量逻辑回归确定（1）抗病毒治疗的预测因子和（2）通过 Cox 回归分析的 HCC 存活预测因子。

斯坦福团队检查了 2129 名 HBV 相关 HCC 患者的记录。该组的平均年龄为 62.7 岁，71% 为男性，40% 为亚裔。尽管该组中有 72% 的人患有肝硬化，但只有 37% 的人服用了抗 HBV 药物。治疗率从之前的 26.3% 提高到 2010 年后的 40.5%，但有几个组的总体治疗率较低：

·      女性

· 非亚洲种族/民族

· 没有肝硬化的人

· 失代偿期肝硬化患者

· 未经胃肠病学家 (GI) 或传染病 (ID) 专家治疗的人

女性和男性（30.1% vs 39.5%）、失代偿期肝硬化或无肝硬化患者与代偿期肝硬化患者（30.1% vs 34.9% vs 49.8%）的抗病毒治疗率存在显着差异（所有差异均P < 0.001），以及在 2003-2010 年与 2011-2021 年接受护理的人之间（26.3% 与 40.5%）。

按种族或民族，亚洲人接受抗病毒药物治疗的比例最高（51.7%），其次是黑人（35.7%）、白人（23.9%）和西班牙裔（22.9%）（P < 0.001）。按提供者类型，仅接受 GI 或 ID 提供者治疗的患者最有可能获得抗病毒药物（42.0%），其次是接受 GI 或 ID 提供者和肿瘤学家治疗的患者（34.4%），未接受 GI 或 ID 提供者治疗的患者或肿瘤科医生 (32.7%) 和仅由肿瘤科医生治疗的患者 (30.8%) (P = 0.0013)。

多变量逻辑回归确定亚洲人获得抗 HBV 抗病毒药物的可能性是白人的 3.5 倍（调整优势比 3.57，95% 置信区间 2.82 至 4.53，P < 0.001）。在 HCC 诊断之前或之时而不是在诊断之后开始使用抗病毒药物可使生存率提高约 15%（调整后的风险比为 0.84，95% 置信区间为 0.72 至 0.99，P = 0.037）。

在 HCC 诊断时或之前开始使用抗病毒药物提高生存率——再加上接受治疗的人之间存在许多差异——强调需要提高所有社区对抗病毒药物益处的认识并改善对专家的访问。

参考
1. Kudaravalli S, Kam LY, Huang DQ, Cheung R, Nguyen MH。在美国，抗病毒治疗的使用及其对慢性乙型肝炎病毒相关肝细胞癌 (HBV-HCC) 患者生存率的影响。 AASLD—肝脏会议，2022 年 11 月 4 日至 8 日，华盛顿特区。摘要 1161。

StephenW

Anti-HBV Therapy at or Before HCC Diagnosis Improves Survival…..


….only 37% received therapy, lower rates of treatment for non-Asians


AASLD—The Liver Meeting, November 4-8, 2022, Washington, DC

Mark Mascolini

Getting antiviral therapy for hepatitis B virus (HBV) infection at or before HBV-related hepatocellular carcinoma (HCC) diagnosis was independently linked to improved survival among people in a nationwide US insurance and prescription claims database [1]. Women, non-Asians, people without specialist care, and a few other groups proved less likely to get anti-HBV therapy.

Research ties anti-HBV therapy to better survival with HBV-related HCC, but Stanford University investigators who conducted this study noted that much of this work is limited to patient subgroups or to people treated in tertiary-care centers. No one knows if results of these focused studies apply to the general population with HCC. Furthermore, the Stanford team observed, current chronic HBV guidelines do not make specific antiviral recommendations for  HCC.

To get a wider view of antiviral access and impact in people with HBV-related HCC, the Stanford researchers gathered data on a real-world cohort of people with HCC seen in routine practice across the United States. These retrospective numbers came from the Optum Clinformatics Database of eligibility, medical claims, and prescription claims data for the years 2003-2021 [2]. The researchers aimed to estimate how often and when people with HBV-related HCC took antivirals, to search for disparities in anti-HBV medication use, and to determine antivirals’ impact on survival.

The investigators used ICD-9-CM or ICD-10-CM codes to find people 18 or older with HBV-related HCC, to determine how many got anti-HBV antiviral therapy, to compare survival of antiviral-treated and -untreated people, and to identify (1) predictors of antiviral treatment with multivariable logistic regression and (2) predictors of HCC survival with Cox regression analysis.

The Stanford team examined records of 2129 people with HBV-related HCC. The group’s age averaged 62.7 years, 71% were men, and 40% were Asian. Although 72% of the group had cirrhosis, only 37% took anti-HBV drugs. The treatment rate had improved to 40.5% after 2010 from 26.3% earlier, but several groups had lower overall treatment rates:

·      Women

·      Non-Asian races/ethnicities

·      People without cirrhosis

·      People with decompensated cirrhosis

·      People not treated by a gastroenterologist (GI) or infectious disease (ID) specialist

Antiviral treatment rates differed significantly (P < 0.001 for all differences) between women and men (30.1% vs 39.5%), between people with decompensated cirrhosis or no cirrhosis versus those with compensated cirrhosis (30.1% vs 34.9% vs 49.8%), and between people who received care in 2003-2010 vs 2011-2021 (26.3% vs 40.5%).

By race or ethnicity, Asians had the highest proportion treated with antivirals (51.7%), followed distantly by blacks (35.7%), whites (23.9%), and Hispanics (22.9%) (P < 0.001). By provider type, those treated by GI or ID providers only were the most likely to get antivirals (42.0%), followed by those treated by GI or ID providers and oncologists (34.4%), those not treated by a GI or ID provider or an oncologist (32.7%), and those treated only by an oncologist (30.8%) (P = 0.0013).

Multivariable logistic regression determined that Asians were about 3.5-fold more likely than whites to get anti-HBV antivirals (adjusted odds ratio 3.57, 95% confidence interval 2.82 to 4.53, P < 0.001). Starting antivirals before or at the time of HCC diagnosis rather than after diagnosis was associated with about 15% improved survival (adjusted hazard ratio 0.84, 95% confidence interval 0.72 to 0.99, P = 0.037).

Improved survival with antivirals started at or before HCC diagnosis—coupled with the many disparities among those treated—underlines the need to improve awareness of antiviral benefits in all communities and to improve access to specialists.

References
1. Kudaravalli S, Kam LY, Huang DQ, Cheung R, Nguyen MH. Utilization of antiviral therapy and its impact on survival rates in patients with chronic hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) in the United States. AASLD—The Liver Meeting, November 4-8, 2022, Washington, DC. Abstract 1161.