柯阳, 钟鉴宏, 游雪梅, 黄盛鑫, 梁泳荣, 向邦德, 黎乐群. 抗病毒治疗对乙型肝炎病毒相关性肝细胞癌患者根治性术后的影响[J]. 中国肿瘤临床, 2013, 40(19): 1184-1188. DOI: 10.3969/j.issn.1000-8179.20131131
引用本文: 柯阳, 钟鉴宏, 游雪梅, 黄盛鑫, 梁泳荣, 向邦德, 黎乐群. 抗病毒治疗对乙型肝炎病毒相关性肝细胞癌患者根治性术后的影响[J]. 中国肿瘤临床, 2013, 40(19): 1184-1188. DOI: 10.3969/j.issn.1000-8179.20131131
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Yang KE, Jianhong ZHONG, Xuemei YOU, Shengxin HUANG, Yongrong LIANG, Bangde XIANG, Lequn LI. Antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after radical hepatectomy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2013, 40(19): 1184-1188. DOI: 10.3969/j.issn.1000-8179.20131131
Citation: Yang KE, Jianhong ZHONG, Xuemei YOU, Shengxin HUANG, Yongrong LIANG, Bangde XIANG, Lequn LI. Antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after radical hepatectomy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2013, 40(19): 1184-1188. DOI: 10.3969/j.issn.1000-8179.20131131
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抗病毒治疗对乙型肝炎病毒相关性肝细胞癌患者根治性术后的影响

Antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after radical hepatectomy

    摘要
  • 摘要:
      目的  评价抗病毒治疗对乙型肝炎病毒(hepatitis B virus，HBV)相关性肝细胞癌(hepatocellular carcinoma，HCC)患者根治性手术预后的影响。
      方法  回顾性分析478例HBV-HCC根治性术后患者，分为拉米夫定抗病毒治疗组141例和空白对照组337例，比较两组无瘤生存率、总生存率、复发时再治疗措施选择和死亡原因。经倾向性评分匹配法(propensity score matching，PSM)平衡组间协变量，再次分析以上指标。
      结果  经平均28个月随访，治疗组和对照组术后1、3、5年无瘤生存率分别为73.1%、54.7%、44.5%和70.8%、58.2%、52.0%(P=0.778)；总生存率分别为92.1%、84.4%、79.1%和86.9%、66.1%、54.5%(P=0.002)；PSM后观察到相似结果；匹配后亚组分析显示抗病毒治疗明显提高巴塞罗那肝癌分期(Barcelona Clinical Liver Cancer staging system，BCLC)A/B期患者总生存率(P=0.035)，但未能显著提高BCLC-C期患者总生存率(P=0.775)；治疗组复发时获得再次根治性、姑息性治疗的例数分别为28例和24例，对照组19例和38例(P=0.031)；治疗组死于肿瘤复发进展、肝功能衰竭的例数分别为18例和11例，对照组23例和36例(P=0.041)。
      结论  HBV-HCC根治性术后抗病毒治疗虽未能有效提高患者无瘤生存率，但使患者在复发时获得更多根治性治疗的机会并减少肝衰竭发生，明显延长了术后生存时间，尤其对于早、中期患者。

     

    Abstract:
      Objective   The effect of antiviral therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radical hepatectomy was assessed.
      Methods   A total of 478 HBV-HCC patients treated by radical hepatectomy were retrospectively collected. Patients in the treatment group (n=141) received postoperative lamivudine therapy (100 mg/d), whereas patients in the control group (n=337) did not. Recurrence-free survival rates, overall survival rates, treatments for recurrent HCC and cause of death were compared between the two groups. Propensity score matching was also conducted to reduce confounding bias between the groups.
      Results   The one-, three-, and five-year recurrence-free survival rates didn't significantly differ between the two groups (P=0.778); however, the one-, three-, and five-year overall survival rates in the treatment group were significantly higher than those in the control group (P= 0.002). Similar results were observed in the matched data. Subgroup analysis showed that antiviral treatment conferred a significant survival benefit for Barcelona Clinical Liver Cancer stage A/B patients. Following HCC recurrence, more people in the treatment group were able to choose curative treatments than those in the control group (P=0.031). For cause of death, fewer people in the treatment group died of liver failure than those in the control group (P=0.041).
      Conclusion   Postoperative antiviral therapy increases chances of receiving curative treatments for recurrent HCC and prevents death because of liver failure, thereby significantly prolonging overall survival, especially in early- or intermedian-stage tumors.

     

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