恩替卡韦和替诺福韦酯对HBV相关肝内胆管癌预后的影响

肝脏 ›› 2024, Vol. 29 ›› Issue (10): 1180-1183.

恩替卡韦和替诺福韦酯对HBV相关肝内胆管癌预后的影响

苗慧, 时良慧, 万迁迁, 杨子玉, 孙保木, 万旭英

201805 上海海军军医大学第三附属医院中西医结合科

收稿日期:2023-11-05 出版日期:2024-10-31 发布日期:2024-12-02
通讯作者: 万旭英,Email: wanxuying@126.com
基金资助:
上海市卫健委临床研究专项(2023060)

Prognostic difference between entecavir and tenofovir treatments in patients with hepatitis B related intrahepatic cholangiocarcinoma

MIAO Hui, SHI Liang-hui, WAN Qian-qian, YANG Zi-yu, SUN Bao-mu, WAN Xu-ying

Department of Integrative Medicine, the Third Affiliated Hospital of Naval Medical University, Shanghai 201805, China

Received:2023-11-05 Online:2024-10-31 Published:2024-12-02
Contact: WAN Xu-ying,Email: wanxuying@126.com

摘要/Abstract

摘要： 目的了解恩替卡韦(ETV)和替诺福韦酯(TDF)对HBV相关肝内胆管癌(ICC)预后的影响。方法纳入HBV相关ICC患者96例,其中口服TDF者25例,口服ETV者71例。比较两组患者生存期(OS)和疾病无进展期(PFS)。结果 TDF组中位OS为38个月,ETV中位OS为30个月,差异无统计学意义(P=0.514)。TDF组1年、3年、5年生存率分别为92.0%、46.2%、30.8%,ETV组分别为94.1%、39.9%、13.5%。TDF组中位PFS为25个月,1年、3年、5年无进展生存率分别为75.8%、38.0%、12.7%;ETV组中位PFS为20个月,1年、3年、5年无进展生存率分别为71.1%、30.0%、12.9%。两组PFS差异无统计学意义(P=0.403)。Cox多因素分析提示TNM分期、根治性手术、淋巴结转移、HBV DNA＞10⁴ IU/mL为预后的独立影响因素。结论 ETV和TDF对HBV相关ICC预后的影响无明显差异,但尚待更大样本进一步证实。

关键词: 肝内胆管癌, 乙肝, 抗病毒, 恩替卡韦, 替诺福韦

Abstract: Objective To determine whether the long-term use of different antiviral agents entecavir (ETV) or tenofovir (TDF) has impact on the prognosis of hepatitis B related intrahepatic cholangiocarcinoma (ICC). Methods A retrospective analysis was performed in 96 patients with hepatitis B related ICC, including 25 cases with TDF treatment, and 71 cases with ETV treatment. The long-term overall survival (OS) and disease progression free survival (PFS) periods were compared between the two groups. Results The median OS of TDF group was 38 months and that of ETV was 30 months. The 1-year, 3-year and 5-year survival rates of TDF group were 92.0%, 46.2% and 30.8%, respectively. The 1-year, 3-year and 5-year survival rates of ETV group were 94.1%, 39.9% and 13.5%, respectively, but there was no significant difference between the two groups (P=0.514). The median PFS in TDF group was 25 months, and the 1-year, 3-year and 5-year progression free survival rates were 75.8%, 38.0% and 12.7%, respectively; The median PFS in ETV group was 20 months, and the 1-year, 3-year and 5-year progression free survival rates were 71.1%, 30.0% and 12.9%, respectively. Similarly, there was no significant difference in PFS between the two groups (P=0.403). Cox multivariate analysis showed that TNM stage, radical surgery, lymph node metastasis and HBV DNA > 104 IU/ml were independent prognostic factors. Conclusion There is no significant difference between the treatments with antiviral drugs ETV and TDF in the prognosis of hepatitis B related ICC. This result is awaiting further confirmation by retrospective analysis with a larger number of patients.

Key words: Intrahepatic cholangiocarcinoma, Hepatitis B, Antiviral, Entecavir, Tenofovir

苗慧, 时良慧, 万迁迁, 杨子玉, 孙保木, 万旭英. 恩替卡韦和替诺福韦酯对HBV相关肝内胆管癌预后的影响[J]. 肝脏, 2024, 29(10): 1180-1183.

MIAO Hui, SHI Liang-hui, WAN Qian-qian, YANG Zi-yu, SUN Bao-mu, WAN Xu-ying. Prognostic difference between entecavir and tenofovir treatments in patients with hepatitis B related intrahepatic cholangiocarcinoma[J]. Chinese Hepatolgy, 2024, 29(10): 1180-1183.

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参考文献

[1] Zhang H, Yang T, Wu M, et al.Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management[J]. Cancer Lett,2016, 379(2):198-205.
[2] Khan SA, Emadossadaty S, Ladep NG, et al. Rising trends in cholangiocarcinoma: is the ICD classification system misleading us[J]? J Hepatol, 2012, 56(4):848-854.
[3] Ke Q ,Lin N,Deng M, et al. The effect of adjuvant therapy for patients with intrahepatic cholangiocarcinoma after surgical resection: a systematic review and meta-analysis[J]. PLoS One, 2020, 15(2):e0229292.
[4] Clements O,Eliahoo J,Kim JU, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a systematic review and meta-analysis[J]. J Hepatol, 2020, 72(1):95-103.
[5] Palmer WC,Patel T. Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma[J]. J Hepatol, 2012, 57(1):69-76.
[6] Corrao S,Natoli G,Argano C. Nonalcoholic fatty liver disease is associated with intrahepatic cholangiocarcinoma and not with extrahepatic form: definitive evidence from meta-analysis and trial sequential analysis[J]. Eur J Gastroenterol Hepatol, 2021, 33(1):62-68.
[7] Wongjarupong N,Assavapongpaiboon B,Susantitaphong P, et al. Non-alcoholic fatty liver disease as a risk factor for cholangiocarcinoma: a systematic review and meta-analysis[J]. BMC gastroenterol, 2017, 17(1):149.
[8] Lee TY,Hsu YC,Yu SH, et al. Effect of nucleos(t)ide analogue therapy on risk of intrahepatic cholangiocarcinoma in patients with chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2018, 16(6):947-954.e944.
[9] Lei Z,Xia Y,Si A,et al. Antiviral therapy improves survival in patients with HBV infection and intrahepatic cholangiocarcinoma undergoing liver resection[J]. J Hepatol, 2018, 68(4):655-662.
[10] Zhang Z,Zhou Y,Yang J, et al.The effectiveness of TDF versus ETV on incidence of HCC in CHB patients: a meta analysis[J]. BMC cancer, 2019, 19(1):511.
[11] Choi J,Kim HJ,Lee J, et al. Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B: a korean nationwide cohort study[J]. JAMA oncol, 2019, 5(1):30-36.
[12] Choi J,Jo C,Lim Y S. Tenofovir versus entecavir on recurrence of hepatitis B virus-related hepatocellular carcinoma after surgical resection[J]. Hepatology, 2021,73(2): 661-673.
[13] Dave S, Park S, Murad MH, et al. Comparative effectiveness of entecavir versus tenofovir for preventing hepatocellular carcinoma in patients with chronic hepatitis B: a systematic review and meta-analysis[J]. Hepatology, 2021.73(1): 68-78
[14] Murata K,Asano M,Matsumoto A, et al. Induction of IFN-λ3 as an additional effect of nucleotide, not nucleoside, analogues: a new potential target for HBV infection[J]. Gut, 2018, 67(2):362-371.
[15] Murata K,Tsukuda S,Suizu F, et al. Immunomodulatory mechanism of acyclic nucleoside phosphates in treatment of hepatitis B virus infection[J]. Hepatology, 2020, 71(5):1533-1545.
[16] Hu JY, Zhou HB, Liu WD, et al. A comparative study of intrahepatic cholangiocarcinoma and hepatocellular carcinoma with reference to clinical features and prognosis[J]. Zhonghua Gan Zang Bing Za Zhi, 2019, 27(7):511-515.