抗病毒治疗提高乙型肝炎病毒相关原发性肝癌患者两年生存率

Improvement of improve the two years survival rate of patients with hepatitis B virus-related primary liver cancer after antiviral treatment

目的探讨乙型肝炎病毒(HBV)DNA水平和抗病毒治疗对HBV相关的原发性肝癌(HBV-PLC)患者预后的影响。方法回顾性分析2008年1月至2012年12月首都医科大学附属北京地坛医院收治的632例HBV-PLC患者的临床资料。收集病毒学指标及其他基线数据,根据肝癌发生前至基线确诊时是否抗病毒治疗分为确诊前抗病毒组(230例)和确诊前未抗病毒组(402例);进一步根据肝癌确诊前未抗病毒组(402例)在确诊后是否抗病毒分为确诊后抗病毒组(325例)和确诊后未抗病毒组(77例)。运用Kaplan-Meier生存曲线对不同组间的生存率进行分析比较。结果 Cox多因素分析显示肿瘤数量、直径、门脉栓塞、天门冬氨酸氨基转移酶、γ-谷氨酰基转肽酶、甲胎蛋白、中性粒细胞/淋巴细胞比值、BCLC分期、基线HBV DNA载量均为影响患者预后的独立危险因素,相对危险度[Exp(β)]分别为1.309、1.734、1.599、1.002、1.001、1.486、1.200、2.528和1.282。Kaplan-Meier生存曲线分析显示,与HBV DNA阳性组相比,HBV DNA低于检测下限患者的2年生存率显著升高(χ2=7.297,P=0.007);分层分析显示,基线HBV DNA<500 IU/ml组与HBV DNA≥105 IU/ml组的生存率差异具有统计学意义(χ2=6.735,P=0.009)。确诊前抗病毒组的两年生存率显著高于确诊前未抗病毒组(χ2=33.792,P=0.000);进一步结果显示,确诊后抗病毒组的两年生存率显著高于确诊后未抗病毒组(χ2=33.179,P=0.000)。结论 HBV相关的原发性肝癌患者的基线HBV DNA的水平与其预后密切相关,HBV DNA水平越高预后越差,而抗病毒治疗能够显著提高患者的两年生存率。

Objective To investigate the relationship between HBV DNA, antiviral therapy and prognosis of patients with hepatitis B virus-related primary liver cancer（HBV-PLC）. Methods Total of 632 patients diagnosed as HBV-PLC between January 2008 and December 2012 in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively. All the baseline data of the patients were recorded before treatment including the virus index. According to the antiviral therapy or not before diagnosis, all the patients were divided into the antiviral（230 cases） and non-antiviral groups（402 cases）. Furthermore, the 402 cases without antiviral therapy were divided into the antiviral（325 cases） and non-antiviral groups（77 cases）. The Kaplan-Meier survival analysis was perfomed to compare the overall survival of the patients with HBV-PLC in different groups. Results Multivariate Cox analysis showed that tumor number and diameter, the portal vein tumor thrombus, aspertate aminotransferase, gamma glutamyl transpeptidase, alpha fetoprotein,neutrophils/lymphocyte ratio, BCLC staging and HBV DNA levels were the independent risk factors affecting the prognosis of HBV PLC [Exp（β）]： 1.309, 1.734, 1.599, 1.002, 1.001, 1.486, 1.001, 1.486 and 1.282, respectively. The Kaplan-Meier survival analysis showed that the HBV DNA negative group had higher twoyear survival rate than HBV DNA positive group（χ^2 = 7.297, P = 0.007）. Stratificationl analysis showed that the survival of rates of HBV DNA 500 IU/ml group and HBV DNA ≥ 105 IU/ml group were with significant difference（χ^2 = 6.735, P = 0.009）. Compared with non-antiviral therapy before diagnosis, antiviral therapy could significantly increase the two-year survival rate（χ^2 = 33.792, P = 0.000）. Meanwhile, after the antiviral therapy in the observation period after diagnosis could also increase the rate of two-year survival patients with HBV-PLC（χ^2 = 33.179, P = 0.000）. Conclusions The HBV DNA level is closely related to the prognosis of patients with HBV-PLC. In addition, antiviral treatment could improve the two-year survival rates of patients with HBV-PLC.