乙型肝炎病毒相关性肝细胞癌术后应用核苷(酸)类药物治疗

Nucleoside / Nucleotide Analogues for Hepatitis B Virus-Related Hepatocellular Carcinoma after Radical Hepatectomy

慢性乙型肝炎患者运用核苷(酸)类药物(NAs)治疗已取得良好抗病毒效果,并降低了肝细胞癌(HCC)发生的风险,故研究人员推测乙型肝炎病毒(HBV)相关性HCC患者术后应用NAs亦有可能获益。2004年来有关HBV相关性HCC根治性手术后应用NAs疗效的研究不断增多,这些研究的气泡图系统汇总结果显示:HBV相关性HCC术后应用NAs治疗可明显提高患者无瘤生存率和总生存率;HBV相关性HCC患者HBV-DNA阳性,应给予NAs治疗;初始治疗者优先选用强效高耐药屏障药物,且应密切监测HBV耐药情况;对于拉米夫定耐药患者可加用阿德福韦酯或换用恩替卡韦长期治疗。

Significant advances have been made in nucleoside（nucleotide） analogues （NAs） therapy to treat chronic hepatitis B, and this therapy reduces the risk of hepatitis B virus （HBV）-related hepatocellular carcinoma （ HCC） in some patients, therefore some researchers reason NAs may also benefit HBV-related HCC patients after radical hepatectomy.From 2004, there are more and more studies which investigated out-comes of antiviral therapy with NAs for HBV-related HCC.Now a systematical review has been made for these studies by bubble plots and the results show that postoperative NAs therapy not only increases recur-rence-free survival rates, but also enhances overall survival rates.Patients with HCC should take NAs if they have positive HBV-DNA.For patients with no NA treatment history, the potent and high-resistance-barrier drugs should be the best choice, and close monitoring of HBV resistance at the same time is indispensable;moreover, for lamivudine-resistant patients, adefovirdipivoxil plus lamivudine or entecavir should be used for long term treatment.