乙型肝炎病毒基因亚型B2和C2对肝细胞癌形成、疗效及预后的影响

Role of HBV subgenotype C2,B2 in carcinogenesis,treatment and prognosis of hepatocellular carcinoma

目的:探讨乙型肝炎病毒基因亚型B2和C2在肝细胞癌(HCC)形成、治疗和预后中的作用。方法:检测462例HCC患者和234例慢性乙型肝炎(CHB)患者的基因型及亚型,并对其中采取手术切除或经肝动脉插管栓塞化疗(transarterial chemoembolization,TACE)或两者联合治疗的228例基因亚型为B2或C2的HCC患者随访观察1年。结果:C2亚型HCC患者比B2亚型手术治疗机会多(P=0.007);多因素分析发现,男性(P=0.000)、年龄≥40岁(P=0.030)、病毒载量>10000 copies/ml(P=0.017)是HCC形成的独立危险因素,而亚型B2和C2对HCC形成的危险性无统计学差异;50岁以下(P=0.044)、非手术治疗患者(P=0.000)、HBV基因亚型B2(P=0.027)是复发的独立危险因素;B2、C2和混合型感染者HCC组织病理分型上都以粗梁型为主(85.7%、71.2%、75.0%),各种病理类型的构成比无统计学差异;一些少见病理类型中全部为C2亚型,未见B2型和混合型。结论:HBVC2和B2亚型在促进HCC形成的危险性上无统计学差异,但后者形成的HCC恶性程度更高、手术机会较少、更易复发。

Objective：To investigate the role of HBV subgenotypes B2, C2 in the carcinogenesis, treatment and prognosis of hepatocellular carcinoma （HCC）. Methods： HBV genotypes and subgenotypes were detected in 462 HCC patients and 234 chronic hepatitis B （CHB） patients by a multiplex PCR assay, and HCC patients infected with HBV B2 or C2 were followed up for a year after surgical resection, transarterial chemoembolization（TACE） or a combination of both. Results： The HCC patients infected with HBV C2 had a higher chance to receive surgical treatment than those with B2 （P=0. 007）. Age of 40 years or older （P〈0. 030）, male gender （P= 0. 000）, and viral load （〉10 000 copies/ml） （P=0. 017） were the independent risk factors for the carcinoge-nesis of HCC by using multivariate logistic analysis; however, there was no significant difference in the carcinogenesis of HCC between CHB patients with HBV subgenotypes B2 and C2. Age of 50 years or younger （P=0. 044）, infection with HBV B2 （P=0. 027）, and non-surgical treatment （P：0. 000） were the independent risk factors for the recurrence of HCC. Thick trabecular type was more prevalent in HCC patients infected with HBV B2, C2 and genotype mixture （85.7% ,71.2% and 75.0% ,respectively）, and the proportions of histopatbological types were not significantly different between HCC patients infected with HBV B2, C2 and genotype mixture. HBV subgenotype C2 was found in all HCC patients with rare histopatbological type and subgenotype 132 and mixture were no found. Conclusion： There is no significant difference in the carcinogenesis of HCC between CHB patients with HBV subgenotypes B2 and C2. The HCC patients infected with HBV B2 have a lower chance to receive surgical treatment and are more severe than those with C2. HBV B2 is also closely associated with recurrence of HCC.