乙肝DNA病毒载量对经肝动脉化疗栓塞患者疗效及预后的影响  

Influence of hepatitis B virus DNA load on the efficacy and prognosis of patients undergoing transcatheter arterial chemoembolization

作　　者：谭斌 赵卫[1] 姜永能[1] 易根发[1] 潘文秋 马元锦 卓松波 胡继红[1] TAN Bin;ZHAO Wei;JIANG Yongneng;YI Genfa;PAN Wenqiu;MA Yuanjin;ZHUO Songbo;HU Jihong(Department of Medical Imaging,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032

出　　处：《实用放射学杂志》2023年第3期464-469,共6页Journal of Practical Radiology

摘　　要：目的探讨经肝动脉化疗栓塞(TACE)术前乙肝DNA病毒(HBV-DNA)载量水平对患者疗效和预后的影响。方法选取因原发性肝细胞癌(HCC)行TACE联合抗病毒治疗患者74例,根据术前HBV-DNA载量水平将患者分为3组,A组HBV-DNA阴性(≤1×10^(2) IU/mL)20例;B组HBV-DNA阳性(1×10^(2) IU/mL<HBV-NDA<1×10^(4) IU/mL)24例;C组HBV-DNA阳性(≥1×10^(4) IU/mL)30例。根据改良实体瘤疗效评价标准(mRECIST)评估各组术后3个月、6个月病灶控制情况,分析各组疾病进展时间,总生存期、术后不良反应、HBV-DNA、甲胎蛋白(AFP)情况。结果术后3个月3组肿瘤客观缓解率(ORR)分别为80.0%,66.7%,33.3%,术后6个月分别为60.0%,45.8%,46.7%。3组的中位总生存期(mOS)分别为无法计算,30个月,13个月,其中3组的术后1年生存率分别为90.0%,75.0%,60.0%。3组的中位肿瘤进展时间(mTTP)分别为7个月,6个月,4个月。3组患者术后的HBV-DNA和AFP不同程度下降,其中未出现HBV-DNA再激活情况。3组术后不良反应发生率和肝功能差异无统计学意义。结论TACE术前HBV-DNA>10^(4)IU/mL,患者生存期更短,预后较差。术前HBV-DNA阳性患者,术后病灶更容易进展。单独的TACE治疗对于HBV-DNA载量水平较高的患者,预后和肿瘤控制效果不佳,应加强肿瘤的综合治疗,如TACE术后及时联合消融治疗、靶向治疗、免疫治疗等。Objective To investigate the influence of preoperative hepatitis B virus DNA(HBV-DNA)load level on the effect and prognosis of patients with transcatheter arterial chemoembolization(TACE).Methods Seventy-four patients with hepatocellular carcinoma(HCC)undergoing TACE combined with antiviral therapy were collected and divided into three groups based on the preoperative HBV-DNA load level:group A with negative HBV-DNA(≤1×10^(2) IU/mL)in 20 cases,group B with positive HBV-DNA(1×10^(2) IU/mL<HBV-NDA<1×10^(4) IU/mL)in 24 cases,and group C with positive HBV-DNA(≥1×10^(4) IU/mL)in 30 cases.According to the modified response evaluation criteria in solid tumors(mRECIST),the treatment effect of lesions in each group at 3 month and 6 month postoperative was evaluated,and the time to progression,overall survival,postoperative adverse reactions,HBV-DNA and alpha fetoprotein(AFP)in each group were also analyzed.Results The obj ective response rate(ORR)of the three groups were 80.0%,66.7%and 33.3%at 3 month postoperative,and 60.0%,45.8%,and 46.7%at 6 month postoper ative.The median overall survival(mOS)of the three groups was incalculable,30 months and 13 months respectively,and the postoperative 1-year survival rate was 90.0%,75.0%and 60.0%respectively.The median time to progression(mTTP)of the three groups was 7 months,6 months,and 4 months respectively.The postoperative HBV-DNA and AFP of the three groups were decreased to varying degrees,and there was no reactivation of HBV-DNA.There were no statistically significant differences in the incidence of adverse reactions and liver function of the three groups.Conclusion Patients with HBV-DNA>10^(4) IU/mL preoperative TACE have shorter survival time and poor prognosis.For the patients with positive HBV-DNA preoperative,the lesions are more likely to progress postoperative.For patients with high HBV-DNA load level,TACE alone has poor prognosis and tumor control,so the comprehensive treatment of tumors should be enhanced,such as timely combined ablation therapy,targeted the

关 键 词：乙肝DNA病毒载量 原发性肝细胞癌 肝动脉化疗栓塞 抗病毒治疗 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学] R453