肝癌根治术后拉米夫定抗病毒治疗对乙型肝炎相关性肝细胞癌患者无瘤生存时间的影响

丁韬; 魏涧; 何旭东

doi:10.3969/j.issn.1001-5256.2017.08.017

肝癌根治术后拉米夫定抗病毒治疗对乙型肝炎相关性肝细胞癌患者无瘤生存时间的影响

DOI: 10.3969/j.issn.1001-5256.2017.08.017

1. 湖北医药学院附属东风医院器官移植乳腺外科
2. 湖北医药学院附属东风医院消化内科

基金项目:

十堰市科学技术研究项目(14Y46)；

详细信息

中图分类号: R512.62;R735.7
计量
- 文章访问数: 2227
- HTML全文浏览量: 40
- PDF下载量: 410
- 被引次数: 0
出版历程
- 收稿日期: 2016-12-16
- 出版日期: 2017-08-20

Lamivudine antiviral treatment after radical surgery prolongs disease-free survival of patients with hepatitis B virus-related liver cancer

Department of Organ Transplantation and Breast Surgery, Dongfeng Hospital Affiliated to Hubei Medical College

Research funding:

摘要

摘要: 目的研究肝癌根治术后拉米夫定抗病毒治疗在延长乙型肝炎相关性肝细胞癌（HCC）患者无瘤生存时间中的应用。方法选取2014年3月-2016年3月于湖北医药学院附属东风医院行常规肝癌根治术的乙型肝炎相关性HCC患者120例,60例通过常规处理（A组）、60例通过拉米夫定抗病毒治疗（B组）。通过ELISA法检测所有患者的血清HBV DNA载量,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,利用Kaplan-Meier法对比2组患者的无瘤生存率和复发率,Spearman相关分析探讨患者血清HBV DNA与生存期的关系。结果随访3年后发现所有患者中死亡71例（59.17%）（A组46例死于肿瘤,4例死于肝性脑病;B组20例死于肿瘤,1例死于肝性脑病）。B组复发率、3年内病死率均显著低于A组（48.33%vs 90.00%,35.00%vs83.33%,χ2值分别为16.98、10.34,P值均<0.001）。B组平均无瘤生存期以及术后1、2、3年的无瘤生存率显著高于A组（t=9.82,χ2值分别为7.87、11.4...
- 癌,肝细胞 /
- 拉米夫定 /
- 治疗
Abstract: Objective To investigate whether lamivudine antiviral treatment after radical surgery can prolong disease-free survival of patients with hepatitis B virus-related liver cancer. Methods A total of 120 patients with hepatitis B virus-related liver cancer who underwent conventional radical surgery in Dongfeng Hospital Affiliated to Hubei Medical College from March 2014 to March 2016 were enrolled, and among these patients, 60 were given conventional treatment ( group A) and 60 were given lamivudine antiviral treatment ( group B) .ELISA was used to measure serum HBV DNA level. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the Kaplan-Meier method was used to compare disease-free survival rate and recurrence rate between groups, and the Spearman method was used to investigate the correlation between serum HBV DNA level and survival time. Results According to the results of the 3-year follow-up, 71 patients ( 59. 17%) died ( group A: 46 patients died of tumor and 4 died of hepatic encephalopathy; group B: 20 died of tumor and 1 died of hepatic encephalopathy) . Compared with group A, group B had significantly lower recurrence rate ( 48. 33% vs 90. 00%, χ2= 16. 98, P < 0. 001) and mortality rate within 3 years ( 35. 00%vs 83. 33%, χ2= 10. 34, P < 0. 001) . Group B had significantly higher mean disease-free survival time and 1-, 2-, and 3-year disease-free survival rates than group A ( t = 9. 82, χ2= 7. 87, 11. 43, and 7. 98, all P < 0. 001) . After surgery, group B had a significantly lower serum HBV DNA load than group A [ ( 0. 008 1 ± 0. 003 2) × 105copies/ml vs ( 0. 014 3 ± 0. 008 9) × 105copies/ml, t = 18. 54, P< 0. 001]. In group A, there were significant differences in 1-, 2-, and 3-year disease-free survival rates between patients with serum HBV DNA load ≥1. 0 × 105copies/ml and those with serum HBV DNA load < 1. 0 × 105copies/ml ( χ2= 8. 57, P < 0. 05) , and further analysis showed that there were significant differences in 1-, 2-, and 3-year disease-free survival rates ( χ2= 4. 36, 5. 36, and 9. 53, P< 0. 05) ; in group B, there were no significant differences in 1-, 2-, and 3-year disease-free survival rates between these two groups of patients ( P > 0. 05) . Serum HBV DNA expression was positively correlated with patients' survival time ( r = 0. 67, P < 0. 001) . Conclusion Lamivudine antiviral therapy after radical surgery can effectively reduce serum HBV DNA level, and helps to prolong the disease-free survival time of patients with hepatitis B virus-related liver cancer.
- carcinoma, hepatocellular /
- lamivudine /
- therapy

HTML全文

参考文献(19)

[1]WANG BQ, XUE F, TONG Q, et al.Recurrence-free survival and overall survival in patients with hepatitis B-related liver cancer receiving antiviral therapy[J].J Pract Hepatol, 2015, 18 (2) :132-135. (in Chinese) 王伯庆, 薛峰, 佟庆, 等.抗病毒治疗对乙型肝炎相关肝癌根治术后复发和生存的影响[J].实用肝脏病杂志, 2015, 18 (2) :132-135.

[2]WU YJ, GUO JS.Hepatic stellate cells, Toll-like receptor 4 signaling pathway, and inflammatory fibrotic microenvironment in the development of hepatocellular carcinoma[J].J Clin Hepatol, 2015, 31 (6) :876-879. (in Chinese) 吴玉婧, 郭津生.肝星状细胞、Toll样受体4信号途径、炎症及纤维化微环境与原发性肝癌发生发展的关系[J].临床肝胆病杂志, 2015, 31 (6) :876-879.

[3]ZHOU RR, DENG YD, YUAN H.Epidemiological and clinical features of primary liver cancer:an analysis of 236 patients[J].J Clin Hepatol, 2016, 32 (8) :1538-1542. (in Chinese) 赵荣荣, 邓永东, 袁宏.236例原发性肝癌患者流行病学及临床特点分析[J].临床肝胆病杂志, 2016, 32 (8) :1538-1542.

[4]BAUMERT TF, JHLING F, ONO A, et al.Hepatitis C-related hepatocellular carcinoma in the era of new generation antivirals[J].BMC Med, 2017, 15 (1) :52.

[5]KANDA T, IMAZEKI F, MIKAMI S, et al.Occurrence of hepatocellular carcinoma was not a rare event during and immediately after antiviral treatment in Japanese HCV-positive patients[J].Oncology, 2011, 80 (5-6) :366-372.

[6]WEI MQ, DONG YH.The effect of antiviral therapy on tumcr recurrence after radical surgery for liver cancer[J].Int J Virol, 2015, 22 (3) :199-201. (in Chinese) 魏明琴, 董佑红.肝癌根治术后抗病毒治疗对肿瘤复发率的影响[J].国际病毒学杂志, 2015, 22 (3) :199-201.

[7]TENG CF, WU HC, SHYU WC, et al.Pre-S2 mutant-induced mammalian target of rapamycin signal pathways as potential therapeutic targets for hepatitis B virus-associated hepatocellular carcinoma[J].Cell Transplant, 2017, 26 (3) :429-438.

[8]JIANG E, SHANGGUAN AJ, CHEN S, et al.The progress andprospects of routine prophylactic antiviral treatment in hepatitis B-related hepatocellular carcinoma[J].Cancer Lett, 2016, 379 (2) :262-267.

[9]KOZBIAL K, MOSER S, SCHWARZER R, et al.Unexpected high incidence of hepatocellular carcinoma in cirrhotic patients with sustained virologic response following interferon-free direct-acting antiviral treatment[J].J Hepatol, 2016, 65 (4) :856-858.

[10]SOHN W, KANG TW, CHOI SK, et al.Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma[J].Oncotarget, 2016, 7 (30) :47794-47807.

[11]MA M, NIU TT, SHAO L, et al.Hepatic transcatheter arterial chemoembolization combined with stereotactic radiation therapy of primary liver cancer[J].Trauma Crit Med, 2017, 5 (1) :32-35. (in Chinese) 马明, 牛婷婷, 邵亮, 等.肝动脉化疗栓塞术联合立体定向放疗治疗较大原发性肝癌临床研究[J].创伤与急危重病医学, 2017, 5 (1) :32-35.

[12]ZHANG J, NGUYEN D, HU KQ.Chronic hepatitis C virus infection:a review of current direct-acting antiviral treatment strategies[J].N Am J Med Sci (Boston) , 2016, 9 (2) :47-54.

[13]LIU X, YU L, HAN C, et al.Polymorphisms of HLA-DQB1 predict survival of hepatitis B virus-related hepatocellular carcinoma patients receiving hepatic resection[J].Clin Res Hepatol Gastroenterol, 2016, 40 (6) :739-747.

[14]WANG ZS, HOU AM.Analysis on the risk factors of primary hepatic cancer related to viral infections[J].Int J Virol, 2015, 22 (6) :399-402. (in Chinese) 王智珊, 侯安明.病毒感染相关性原发性肝癌患病危险因素分析[J].国际病毒学杂志, 2015, 22 (6) :399-402.

[15]YANG S, LIN Q, LIN W, et al.Effect of adjuvant interferon therapy on hepatitis B virus-related hepatocellular carcinoma:a systematic review[J].World J Surg Oncol, 2016, 14 (1) :159.

[16]SHIN SR, PAIK SW, GWAK GY, et al.Antiviral therapyin patients after treatment for hepatitis C-related hepatocellular carcinoma[J].Gut Liver, 2011, 5 (1) :77-81.

[17]RAVI S, AXLEY P, JONES D, et al.Unusually high rates of hepatocellular carcinoma after treatment with direct-acting antiviral therapy for hepatitis C related cirrhosis[J].Gastroenterology, 2017, 152 (4) :911-912.

[18]SUN P, YANG X, HE RQ, et al.Antiviral therapy after curative treatment of hepatitis B/C virus-related hepatocellular carcinoma:a systematic review of randomized trials[J].Hepatol Res, 2014, 44 (3) :259-269.

[19]GUO TZ, HAN LX, LUO Y, et al.Risk factors of liver cancer in patients with hepatitis B virus infection[J].Int J Virol, 2016, 23 (1) :26-28. (in Chinese) 郭铁志, 韩立新, 罗研, 等.乙型肝炎病毒感染患者肝癌发病的影响因素研究[J].国际病毒学杂志, 2016, 23 (1) :26-28.

施引文献

资源附件(0)

访问统计