原发性肝癌术后HBV活跃复制者拉米呋啶治疗对肿瘤复发的影响

Effect of postoperative anti-viral therapy using lamivudine on recurrence of hepatocellular carcinoma in patients with active HBV replication

目的探讨肝癌根治术后HBVDNA活跃复制病人应用拉米呋啶治疗对肿瘤复发的影响。方法将41例原发性肝癌根治性切除术后血清HBVDNA〉10^5 copies／ml病人随机分2组：治疗组21例（手术切除＋拉米呋啶），对照组20例（单纯手术切除）；同期22例肝癌根治术后HBVDNA％500 opies／ml病人作阴性组。观察各组术后血清HBVDNA、ALT水平、e抗原表达、复发时间作统计学分析。结果治疗组和对照组术后1年HBVDNA清除率为76．2％和15％（P％0．01），e抗原转阴率为45．5％和22．2％（P〉0．05）；治疗组、对照组、阴性组术后1年肝癌复发率分别为28．98％、50％、22．73％，治疗组显著低于对照组（P=0．022），与阴性组无差异（P=0．508）；治疗组与对照组术后中位复发时间分别为20个月和11个月（P=0．043）。结论肝癌根治术后HBV活跃复制者应用拉米呋啶治疗可提高HBVDNA清除率，有助于延长肿瘤复发时间。

Objective To investigate the effect of postoperative anti-viral therapy using lamivudine on recurrence of hepatocellular carcinoma （HCC） in patients with active HBV replication. Methods Forty-one HCC patients with high serum HBVDNA level （〉 10^5copies/ml） undergoing radical hepatectomy were randomized into two groups. The patients in group I （n=20） received hep- atectomy alone while those in group Ⅱ （n= 21） received postoperative lamivudine therapy. Another 22 HBVDNA-negative （〈500 copies/ml） HCC patients receiving hepatectomy in the same period of time were employed to serve as negative contract group （Ⅲ ）. The serum levels of HBVDNA and ALT, HBeAg seroconversion rate, tumor recurrence rate were observed and compared by SPSS software. Results In Group I and Group Ⅱ , the 1-year HBVDNA suppression rate was 76.2% vs 15% （P%0. 01） and HBeAg seroconversion rate 45. 5% vs. 22.2% （P〉0. 05）. The median recurrence time was 20 vs. 11 months （P〈0. 001）. The tumor recurrence rate in Group Ⅰ , Ⅱ and Ⅲwas 50%, 28. 98% and 22. 73% ,respectively. There was significant difference between Group Ⅰ and Ⅱ but no marked difference between Group Ⅱ and Ⅲ. Conclusions Lamivudine therapy may play an important role in suppressing the HBV and delaying the recurrence of HCC in patients with active HBV replication.