抗病毒治疗在乙肝相关性肝癌术后肝内复发中的作用  

The impact of antiviral therapy on postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma

作　　者：倪俊[1] 袁文斌[1] 岑峰[1] 严强[1] 张国雷[1] 顾凤元[1] 

机构地区：[1]浙江省湖州市中心医院外科,313000

出　　处：《中华肝胆外科杂志》2015年第2期91-95,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 分析抗病毒治疗在乙肝相关性肝细胞癌（HCC）术后肝内复发患者中的应用价值.方法 按纳入及排除标准,先后入组2004年1月至2011年12月在本院诊治的65例术后肝内复发且具有抗病毒治疗适应证的HCC患者.研究分为抗病毒组（n=42）和对照组（n=23）.对两组患者复发后累积生存时间、复发时间以及复发后6个月Child-pugh分级、乙肝病毒基因（HBV-DNA）、乙肝病毒e抗原（HBeAg）、甲胎蛋白（AFP）等数据进行对比分析,并对复发后2年生存率进行了多因素分析.结果 与对照组比较,抗病毒治疗组全组及其动脉栓塞化疗（TACE）亚组病例具有更长的累积生存时间（P均＜0.05）.射频消融治疗（RFA）亚组有无抗病毒治疗患者累积生存时间差异无统计学意义（P＞0.05）.抗病毒治疗联合其他治疗方式（TACE、RFA、再次手术）累积生存率的比较：a.单一抗病毒治疗（8例）;b.联合另一种方式治疗（22例）;c.联合另两种方式治疗（10例）;d.联合另三种方式治疗（2例）.其中a∶b;a∶c;a∶d;b∶c;b∶d的P值均＜0.05.复发后6个月两组HBV-DNA比较差异有统计学意义（P＜0.05）.多因素分析表明,复发肿瘤大小、原发肿瘤分级、复发后是否抗病毒治疗、有无肝硬化与复发后2年生存率具有显著相关性（均P ＜0.05）.结论 抗病毒治疗对于HCC术后复发中的存在抗病毒治疗指征的患者具有显著的临床意义;包括抗病毒治疗的联合治疗将能使患者获得更好的预后.Objective To study the impact of antiviral therapy on patients with postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma （HCC）.Methods According to the inclusion and exclusion criteria,65 patients with HCC who were managed in our hospital from January 2004 to December 2011 for intrahepatic recurrence and had indications for antiviral treatment were included into this study.The patients were divided into two groups ; the antiviral and the control groups.Relevant data between these two groups such as cumulative survival after recurrence,Child-Pugh grade,HBV-DNA,HBeAg,AFP at the time of recurrence and 6 months later were studied.An analysis on multiple-factors was carried for survival after recurrence at 2 years.Results When compared with the control group,the antiviral group had better cumulative survival in all the cases and in the TACE cases （P 〈 0.05 respectively）.The cumulative survival in the RFA cases was not significantly different between the two groups （P 〉 0.05）.A comparison was carried out in patients who received antiviral therapy which was combined with one or more other therapies （TACE,RFA,reoperation）：（a） antiviral therapy only （8 patients） ; （b） combined with one therapy （22 patients） ; （c） combined with two therapies （10 patients） ; （d） combined with three therapies （2 patients）.All P values of a：b,a：c,a：d,b：c,b：d were less than 0.05.The blood HBV-DNA of the two groups was significantly different at the time 6 months after recurrence （P 〈 0.05）.The results of multivariate analysis showed the 2-year survival was significantly correlated with recurrent tumor size,primary tumor class,antiviral therapy or not after recurrence,presence of absence of cirrhosis.All P values were less than 0.05.Conclusions Antiviral therapy had remarkable clinical impact on HCC patients with postoperative intrahepatic recurrence and with indication for antiviral treatment.Patients had better prognosis if antiviral therapy

关 键 词：乙肝相关性肝癌 抗病毒治疗 肝内复发 累积生存时间 

分 类 号：R735.7[医药卫生—肿瘤]