HBV DNA高载量的肝细胞癌患者肝癌根治术后抗病毒治疗疗效观察

Efficacy of antiviral therapy in hepatocellular carcinoma patients with high HBV DNA levels after radical resection

目的评估抗病毒治疗对HBV DNA高载量肝细胞癌(HCC)患者根治术后的疗效。方法回顾性分析2007年1月-2010年1月行肝癌根治术的113例伴HBV DNA高载量HCC患者的临床资料,其中74例行抗病毒治疗(治疗组),39例未行任何抗病毒治疗(对照组),均给予基础保肝、支持治疗。对所有患者进行随访,比较2组患者术后HBV DNA定量、肿瘤复发率及生存率差异。组间比较采用t检验或χ2检验,Kaplan-Meier法分析术后生存率,Log-rank检验比较2组术后生存。结果治疗组术后HBV DNA载量持续下降,术后6、12、24个月与术前比较,差异均有统计学意义(t值分别为:14.38、18.50、16.22,P<0.05),治疗组与对照组HBV DNA载量分别在术后6、12、24个月差异有统计学意义(t值分别为:13.19、24.20、14.15,P<0.05)。2组患者术后3年无瘤生存率差异有统计学意义(P=0.029)。治疗组与对照组的1、2、3年累计生存率分别为:95.95%、85.14%、75.68%和87.18%、69.23%、53.85%,2组术后3年累计生存率差异有统计学意义(P=0.016)。结论对HBV DNA高载量肝癌术后抗病毒治疗可提高肿瘤3年无瘤生存率,延长术后生存期,因此对于HBV DNA高载量HCC患者行肝癌根治术后,宜尽早、规律、持续联合抗病毒治疗。

Objective To evaluate the efficacy of antiviral therapy in hepatocellular carcinoma （HCC） patients with high HBV DNA levels after radical resection. Methods A retrospective analysis was performed on the clinical data of 113 HCC patients with high HBV DNA levels who underwent radical resection from January 2007 to January 2010. These patients were divided into treatment group （n = 74） and control group （ n = 39 ）. In addition to liver - protecting therapy and supportive care, antiviral therapy was given to the treatment group, but not in the control group. All patients were followed up after operation, and the two groups were compared in terms of HBV DNA level, tumor recurrence rate, and survival rate. Comparison between the two groups was made by t test or ehi - square test ; the Kaplan - Meier method was used to calculate postoperative survival rates, and the log - rank test was used for survival difference analysis. Results After operation, the treatment group had a continuously decreased HBV DNA level, which was significantly lower at 6, 12, and 24 months after operation than before operation （ t = 14. 38, 18. 50, 16. 22, P 〈0.05 ） ; there were significant differences in HBV DNA levels at 6, 12, and 24 months after operation between the treatment group and control group （ t = 13.19, 24. 20, 14. 15, P 〈 0.05 ）. The 3 - year disease - free survival （DFS） rate showed significant difference between the two groups after operation （ P = 0. 029 ）. The 1 - , 2 - , and 3 - year cumulative survival rates were 95.95% , 85.14% , and 75.68% , respectively, in the treatment group and 87.18% , 69.23% , and 53.85% , respectively, in the control group ; the treatment group had a significantly higher 3 - year cumulative survival rate than the control group （ P = 0.016）. Conclusion Antiviral therapy can increase 3 - year DFS rate and prolong postoperative survival in HCC patients with high HBV DNA levels after radical resection. Thus, antiviral therapy should be performed early, regularly, and persistently in HCC patients with high HBV DNA levels.