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

作　　者：柯阳[1] 钟鉴宏[1] 游雪梅[1] 黄盛鑫[1] 梁泳荣[1] 向邦德[1] 黎乐群[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁市530021

出　　处：《中国肿瘤临床》2013年第19期1184-1188,共5页Chinese Journal of Clinical Oncology

基　　金：国家科技重大专项课题项目(编号:2012ZX10002010);广西科学研究与技术开发计划项目(编号:桂科攻10124001A-4)资助~~

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。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 col-lected. 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 com-pared 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 sur-vival 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 sur-vival, especially in early-or intermedian-stage tumors.

关 键 词：抗病毒治疗 肝细胞癌 倾向性评分匹配法 无瘤生存率 生存率 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]