肝脏 ›› 2021, Vol. 26 ›› Issue (10): 1082-1086.

• 肝癌 • 上一篇    下一篇

HBV相关肝癌术后复发的系统性药物治疗疗效分析

张源净, 李铭龙, 王俊学, 谢莹   

  1. 200003 上海 海军军医大学第二附属医院感染科(张源净,王俊学,谢莹);青岛市黄岛区人民医院感染科(李铭龙)
  • 收稿日期:2021-08-15 出版日期:2021-10-31 发布日期:2021-12-07
  • 通讯作者: 王俊学,Email:docd1@sin.com;谢莹,Email:xy870606@126.com
  • 作者简介:共同第一作者:李铭龙
  • 基金资助:
    长征医院人才建设三年行动计划“金字塔人才工程”

Efficacy of systemic drug therapy for postoperative recurrence of HBV related hepatocellular carcinoma

ZHANG Yuan-jing1, LI Ming-long2, WANG Jun-xue1, XIE Ying1   

  1. 1. Department of Infection,Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China;
    2. Department of Infection, Huangdao District People's Hospital, Qingdao 266400, China
  • Received:2021-08-15 Online:2021-10-31 Published:2021-12-07
  • Contact: WANG Jun-xue, Email: docd1@sin.com; XIE Ying, Email: xy870606@126.com

摘要: 目的 观察系统性药物治疗对HBV相关肝癌术后复发患者的的疗效和预后,并分析疗效影响因素。方法 收集43例肝癌术后(包括手术切除、肝移植)复发的患者的基线人口学资料和临床数据,在予以系统性药物治疗(索拉非尼、仑伐替尼、化疗)后,基于RECIST 1.1标准来评估疗效;通过COX回归模型来分析影响HCC患者无进展生存期(PFS)和总生存期(OS)的因素,用Kaplan-meier法绘制生存曲线。结果 疗效评估结果显示PD的患者7例,10 例为PR,26例为SD。单因素分析表明HBV DNA阳性、肿瘤分期BCLC C期显著影响了PFS(P<0.05)。基于OS的分析结果显示,腹水(HR 2.700 95% CI:1.058~6.889,P=0.038)、HBV DNA阳性(HR 2.873 95% CI:1.030~8.012,P=0.044)、AFP高水平(HR 4.753 95% CI:1.404~16.086,P=0.012)、肿瘤分期BCLC C期(HR 7.753 95% CI:2.365~25.414,P=0.001)等因素影响患者生存期,术前BCLC C期患者预后最差,为独立危险因素。结论 腹水、HBV DNA阳性、术前肿瘤分期晚的患者预示系统性药物治疗疗效较差,提示这类患者术后应密切检测病情,及时采取全面的系统治疗,以改善预后。

关键词: 乙型肝炎病毒, 肝细胞癌, 术后, 复发, 系统性药物治疗

Abstract: Objective To investigate the efficacy and prognosis of systemic drug therapy in patients with tumor recurrence after radical resection of HBV-related liver cancer, and analyze its influencing factors. Methods For 43 patients who relapsed after radical resection of liver cancer were finally included, baseline demographic data and clinical data were collected. After receiving systemic drug treatment, the curative effect was evaluated based on the RECIST 1.1 standard; the COX regression model was used to analyze the PFS and PFS of HCC patients. Influencing factors of OS, the survival curve was drawn by Kaplan-Meier method. Results The curative effect evaluation results of the entire group of patients showed that there were 7 patients with PD, 10 patients were PR, and the remaining 26 patients were SD. Univariate analysis showed that HBV DNA-positive patients and patients with tumor stage BCLC C stage affected PFS (P<0.05). OS-based analysis showed that ascites HR (95% CI): 2.700 (1.058~6.889), P=0.038; HBV DNA positive HR (95% CI): 2.873 (1.030~8.012), P=0.044; AFP highly expressed HR (95% CI): 4.753 (1.404~16.086), P=0.012; tumor stage BCLC stage C HR (95% CI): 7.753 (2.365~25.414), P=0.001; these factors all reduce the patient's survival . Among them, patients with BCLC stage C before surgery have the worst prognosis and are independent risk factors. Conclusion Patients with ascites, HBV DNA-positive, and late preoperative tumor staging often indicate a poor prognosis for systemic drug therapy, suggesting that such patients should be actively treated with comprehensive systemic treatment after radical surgery to improve their prognosis.

Key words: Hepatitis B virus, Hepatocellular carcinoma, Radical operation, Recurrence, Systemic drug therapy