抗病毒应答反应对HBV DNA高复制原发性肝癌根治术后疗效的影响

The effect of antiviral response to Entecavir therapy on recurrence of hepatocellular carcinoma with active HBV replication

目的探讨核苷类药物应答反应对HBV DNA阳性原发性肝癌根治术后复发的影响。方法对我科收治的157例HBV DNA高复制的原发性肝癌根治术患者,术后均予恩替卡韦抗乙肝病毒治疗;同期无抗病毒治疗的29例HBV DNA阴性肝癌根治术患者作为对照组。统计分析各患者的抗病毒应答反应、临床病理资料、肿瘤复发时间及无瘤生存期,及其各指标的相关性。结果 1)肝癌术后恩替卡韦治疗后24、48周HBV DNA转阴率为70.1%和90.2%;2)早期应答组、应答不良组、HBV DNA阴性组术后中位复发时间分别为26、20和28个月,早期应答组显著优于应答不良组(P=0.032),与阴性组比较无显著改变(P=0.242);3)早期应答组、应答不良组、HBV DNA阴性组术后1、3年的无瘤生存率分别为84.7%、73.0%、87.8%和39.7%、32.20%、40.3%,早期应答组显著优于应答不良组(P=0.024)。4)cox回归多因素分析脉管癌栓、手术切缘、肿瘤数目与肝癌术后近期复发显著相关;脉管癌栓、抗病毒应答、肿瘤分化与肝癌术后晚期复发显著相关。结论抗病毒早期应答有利于HBV DNA阳性肝癌患者根治术后延长复发时间和提高无瘤生存率。

Objective To investigate the effect of antiviral response to Entecavir therapy on recurrence of hepatocellular carcinoma with active HBV replication.Methods A retrospective study was conducted on 157 HCC patients underwent curative resection with high serum HBV DNA level（〉10^3 IU/ml）and 29 cases with negative serum HBV DNA level（〈10^2 IU/ml）.The serum level of HBV DNA at week 24 and 48,as well as tumor recurrence and overall disease-free survivals were determined and compared by SPSS software.Results The nagative rate of HBV DNA at week 24 and 48under Entecavir therapy was70.1% and 90.2%.The median recurrence time of Group early response（I）、Group poor response（II）and Group HBV DNA negative（III）were 26,20,28 months（P〈0.05）;The1-,3-years disease-free survivals rarte in Group I,II and III were84.7%,73.0%,87.8% and 39.7%,32.20%,40.3%（P=0.024）.There was significantly different between Group I and II,and no difference between Group I and III.On multivariate analyses,presence of portal vein tumor thrombus、poor antiviral response、poor tumor differentiation were significant high risk factors of HCC late recurrence.Conclusion Early antiviral response to Entecavir therapy may be useful to delay the recurrence time and promote the overall disease-free survivals for the hepatocellular carcinoma with active HBV replication