抗病毒治疗对乙型肝炎相关性肝癌术后肝内复发患者生存状况的影响

Effect of antiviral therapy on survival of patients with intrahepatic recurrent after surgery for hepatitis B associated hepatocellular carcinoma

目的探讨抗病毒治疗对乙型肝炎病毒(HBV)相关肝癌术后肝内复发患者生存状况的影响。方法回顾性分析2012年1月-2013年6月四川省人民医院107例乙型肝炎相关性肝癌术后发生肝内复发患者的临床资料,根据患者复发后抗病毒治疗情况分为抗病毒组(68例)和对照组(39例)。比较两组患者复发后累积生存时间、复发后6个月乙型肝炎-DNA(HBV-DNA)、乙型肝炎病毒e抗原(HBe-Ag)及甲胎蛋白(AFP)水平。采用Kaplan-Meier法统计两组患者的2年生存率,Cox回归模型分析与患者复发后2年生存率相关的因素。结果抗病毒组的中位生存时间为24个月(15.6~26.1个月),对照组的中位生存时间为14个月(11.2~20.3个月),差异均有统计学意义(P<0.05)。抗病毒组1和2年累积生存率分别为79.71%和39.12%,对照组1和2年累积生存率分别为58.41%和15.71%,差异有统计学意义(P<0.05)。经过正规抗病毒治疗6个月后,抗病毒组患者的HBV-DNA拷贝数低于对照组(P<0.05)。Cox多因素分析显示:原发肝癌的组学分化程度、复发肿瘤≥2 cm及抗病毒治疗是影响肝癌患者肝内复发后2年生存率的主要因素。结论对存在抗病毒治疗指征的肝癌术后肝内复发患者采用正规的抗病毒治疗对提高患者的生存率有积极的作用。

Objective To investigate the impact of antiviral therapy on postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma.Methods The clinical data of 107 patients with intrahepatic recurrence of hepatitis B related hepatocellular carcinoma treated in Sichuan Provincial People’s Hospital from January 2012 to June 2013 were retrospectively analyzed.According to antiviral treatment after relapse they were divided into antiviral group(68 cases)and control group(39 cases).Relevant data such as cumulative survival time after recurrence,and the levels of HBV-DNA,HBeAg and AFP 6 months after recurrence were studied and compared between the two groups.The 2-year survival rate was analyzed by Kaplan-Meier method and the factors related to 2-year survival rate after recurrence was analyzed by Cox regression model.Results The median survival time of the antiviral group was 24(15.6-26.1)months,and that of the control group was 14(11.2-20.3)months,the difference was statistically significant(P<0.05).The 1-year and 2-year survival rates were 79.71%and 39.12%in the antiviral group,and 58.41%and 15.71%in the control group,and the differences were statistically significant(P<0.05).After six months of regular antiviral treatment,the copy number of HBV-DNA in the anti-virus group was significantly lower than that in the control group(P<0.05).Cox multivariate analysis showed that the histological grade of primary liver cancer,size of recurrent tumor≥2 cm and anti-viral treatment were the main factors related to 2-year survival rate after postoperative intrahepatic recurrence in the patients with hepatitis B related hepatocellular carcinoma.Conclusions Application of antiviral therapy in hepatocellular carcinoma patients with intrahepatic recurrence after operation has remarkable effect on improvement of survival rate of the patients.