抗病毒治疗对预防肝癌根治术后肿瘤复发的作用研究

A study of antiviral therapy in prevention of tumor recurrence after curative treatment of hepatocellular carcinoma

目的探讨抗病毒治疗在预防肝细胞癌根治术后肿瘤复发中的作用。方法回顾性分析2006年4月-2009年6月60例接受肝癌根治术患者的临床资料,按患者术前血清乙型肝炎病毒DNA(HBV-DNA)水平和术后是否接受拉米夫定(100mg/d)治疗分为4组(n=15):组Ⅰ(HBV-DNA≥1.0×105拷贝/ml),组Ⅱ(HBV-DNA<1.0×105拷贝/ml),两组患者均未接受术后抗病毒治疗;组Ⅲ(HBV-DNA≥1.0×105拷贝/ml),组Ⅳ(HBV-DNA<1.0×105拷贝/ml),两组患者均接受术后抗病毒治疗。采用SPSS13.0软件进行统计分析,Kaplan-Meier法计算无瘤生存率,log-rank法检验组间差异,Cox风险比例模型进行预后多因素分析。结果患者最长随访时间38个月,随访期间共复发31例(51.7%),死亡25例(41.7%)。组Ⅰ患者的3年无瘤生存率(28.3%)与组Ⅱ(50.9%)、组Ⅳ(59.1%)比较,差异有统计学意义(P=0.029,P=0.006),但组Ⅰ与组Ⅲ(49.1%),组Ⅱ与组Ⅳ比较,差异均无统计学意义(P=0.272,P=0.495)。单因素和Cox多因素分析显示:术前高HBV-DNA水平、术后未进行抗病毒治疗是肿瘤复发的独立危险因素。结论肝癌根治术后抗病毒治疗能降低肿瘤复发率,对术前HBV-DNA高水平复制者,宜尽早行抗病毒治疗。

Objective To evaluate the effects of antiviral therapy in prevention of tumor recurrence after curative treatment for patients with hepatocellular carcinoma （HCC）. Methods Between Apr. 2006 and Jun. 2009,60 patients undergone curative treatment for HCC were enrolled in the retrospective analysis. Patients were assigned into four groups （15 each）：patients in groupⅠ（serum HBV-DNA≥1.0×105copies/ml） and groupⅡ（serum HBV-DNA1.0×105copies/ml） received no lamivudine antiviral therapy after operation; patients in group Ⅲ （serum HBV-DNA≥1.0×105copies/ml） and group Ⅳ （serum HBV-DNA1.0×105copies/ml） received lamivudine （100mg/d） antiviral therapy after operation. SPSS 13.0 software was used for statistical analysis. The Kaplan-Meier method was used to calculate the tumor-free survival rates,Log-rank test was performed to evaluate the differences between groups,and Cox regression model was used in multi-factor prognostic analysis. Results After a 38 months＇ follow-up,the overall recurrence rate and mortality were 51.7% （31 cases） and 41.7% （25 cases）. The 3-year recurrence rate was significantly lower in group Ⅰ （28.3%） than in group Ⅱ （50.9%） and group Ⅳ （59.1%）,respectively （P=0.029,P=0.006）,while no statistical difference was found between group Ⅰ and group Ⅲ （49.1%,P=0.272） or between group Ⅱ and group Ⅳ （P=0.495）. Univariate and multivariate Cox proportional hazard analysis showed that high preoperative serum HBV-DNA level and the lack of postoperative antiviral therapy were independent risk factors for tumor recurrence. Conclusions It is suggested by the present study that antiviral therapy after curative treatment in patients with HCC can reduce the tumor recurrence rate,suggesting that it might be better that patients with a HBV-DNA≥1.0×105copies/ml should receive an antiviral therapy as early as possible after extirpation of the primary tumor.