抗病毒治疗对乙型肝炎病毒相关性肝癌根治性手术后复发的作用研究  

Study of antiviral therapy on recurrence after curative resection in patients with hepatitis B virus related hepatocarcinoma

作　　者：黄玲玲[1] 郑琦[1] 刘豫瑞[1] 

机构地区：[1]福建医科大学附属第一医院肝内科,福州350004

出　　处：《中国医师进修杂志》2016年第6期550-553,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：探讨抗乙型肝炎病毒（HBV）治疗对HBV相关性肝癌根治性手术后肿瘤复发的作用。方法回顾性分析78例接受肝癌根治性手术的原发性肝细胞癌合并HBV感染患者。根据术后是否联合抗HBV治疗及术前血清HBV DNA水平将患者进行分组，肝癌根治术后联合抗HBV治疗45例（治疗组），其中术前HBV高复制（HBV DNA≥10^7 copies/L）28例，术前HBV低复制（HBV DNA〈10^7 copies/L）17例；单纯行肝癌根治性手术33例（对照组），其中术前HBV高复制20例，术前HBV低复制13例。患者中位随访时间11个月，观察复发情况。采用Kaplan-Meier法计算无瘤生存率，Cox风险比例模型进行预后多因素分析。结果随访期间治疗组38例（84.4%，38/45）复发，对照组31例（93.9%，31/33）复发，两组复发率比较差异无统计学意义（P＞0.05）。治疗组HBV高复制患者术后6、12、18和24个月无瘤生存率分别为78.6%、46.4%、32.1%和10.7%，治疗组HBV低复制患者分别为82.4%、64.7%、47.1%和35.3%，对照组HBV高复制患者分别为50.0%、15.0%、5.0%和0，对照组HBV低复制患者分别为92.3%、46.2%、30.8%和15.4%。对照组HBV高复制患者无瘤生存率明显低于治疗组HBV低复制患者和对照组HBV低复制患者，差异有统计学意义（P＜0.05）；治疗组HBV高复制患者与对照组HBV高复制患者、治疗组HBV低复制患者与对照组HBV低复制患者无瘤生存率比较差异无统计学意义（P＞0.05）。多因素分析结果显示，术前血清HBV DNA≥107 copies/L、术后未抗HBV治疗和肿瘤低分化是HBV相关性肝癌根治性手术后复发的独立危险因素（OR=1.987、2.119和2.539，P＜0.05或＜0.01）。结论血清HBV高复制水平及术后未进行抗HBV治疗是肝癌术后复发的独立危险因素，对术前HBV高复制者，宜尽早进行抗HBV治疗。Objective To evaluate the effects of antiviral therapy in prevention of tumor recurrence after curative resection in patients with hepatitis B virus （HBV） related hepatocarcinoma. Methods The data of 78 HBV related hepatocellular carcinoma patients having underwent hepatocarcinoma curative resection were retrospectively analyzed. The patients were divided into 2 groups according to the treatment method and the serum replication level of HBV DNA： 45 patients received antiviral therapy after hepatocarcinoma curative resection （treatment group）, including 28 cases of preoperative HBV DNA high replication level （HBV DNA ≥ 10^7 copies/L）, and 17 cases of preoperative HBV DNA low replication level （HBV DNA 〈 10^7 copies/L）; 33 cases only received hepatocarcinoma curative resection （control group）, including 20 cases of preoperative HBV DNA high replication level, and 13 cases of preoperative HBV DNA low replication level. The median follow-up time was 11 months, and the tumor recurrence was observed. The Kaplan-Meier method was used to calculate the tumor-free survival rate, and Cox regression model was used in multi-factor prognostic analysis. Results In the follow-up period, the tumor recurrence rates in treatment group were 84.4%（38/45）, in control group were 93.9%（31/33）, and there was no statistical difference （P〉0.05）. The tumor-free survival rates at 6, 12, 18 and 24 months after operation in patients with HBV high replication level of treatment group were 78.6%, 46.4%, 32.1%and 10.7%, and in patients with HBV low replication level of treatment group were 82.4%, 64.7%, 47.1%and 35.3%;these in patients with HBV high replication level of control group were 50.0%, 15.0%, 5.0%and 0, and in patients with HBV low replication level of control group were 92.3%, 46.2%, 30.8%and 15.4%. The tumor-free survival rates in patients with HBV high replication level of control group were significantly lower than those in patients with HBV low replication level of treatment group and patient

关 键 词：肝炎病毒 乙型 肝癌 复发 抗病毒治疗 

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