不同抗病毒治疗方案在接受放疗的HBV相关性肝细胞癌中的作用

摘要/Abstract

摘要： 目的探讨恩替卡韦(ETV)与非恩替卡韦抗病毒治疗对HBV相关性肝细胞癌(HCC)放疗患者HBV定量以及肝功能的影响及可能影响因素,并对总体生存时间进行评估。方法回顾性分析南方医科大学南方医院2011年1月至2016年6月收治的128例HBV相关性HCC患者资料,全部患者均接受肝癌病灶三维适形放疗。根据放疗前抗病毒治疗方案分为ETV组87例和非ETV组41例。放疗结束后每4~8周复查肝功能及HBV DNA定量等,并随访观察两组患者1、2和3年生存率及生存时间。比较两组间乙型肝炎再活动率、肝脏毒性发生率及生存率差异。结果放疗结束后ETV组仅有1例患者(1.15%),而非ETV组有12例患者(29.27%)出现乙型肝炎再活动,差异有统计学意义(P=0.000)。放疗后共51例患者出现肝脏毒性,其中ETV组26例(29.89%),非ETV组25例(60.98%),差异有统计学意义(P=0.008)。ETV组与非ETV组的中位生存时间分别为(19.27±2.53)个月(95%CI: 14.305~24.235)和(11.43±5.29)个月(95%CI: 1.059~21.801),两组间3年生存率差异无统计学意义 (P=0.167)。结论在HBV相关性HCC人群中,放疗前进行ETV抗病毒治疗较非ETV治疗能够更有效预防乙型肝炎再活动以及肝脏毒性的出现,然而不同抗病毒治疗方案对患者的长期生存获益并无差异。

关键词: 肝细胞癌, 放疗, HBV, 恩替卡韦, 拉米夫定

Abstract: Objective To investigate the effect of entecavir (ETV) and other antiviral therapies on hepatitis B virus (HBV) quantification and liver function in HBV related hepatocellular carcinoma (HCC) patients receiving radiotherapy and factors influencing, and to evaluate overall survival time.Methods Clinical data of 128 HBV related HCC patients in our hospital from January 2011 to June 2016 were retrospectively analyzed. All the patients received 3-dimensional conformal radiotherapy for liver cancer. Patients were divided into ETV group (87 cases) and non-ETV group (41 cases) according to the antiviral therapy regimen before radiotherapy. After 4-8 weeks of radiotherapy, the liver function, HBV DNA load and other parameters were tested. The 1-, 2-, 3-year survival rate and survival time were also recorded. The reactivation rates of hepatitis B, hepatotoxicity rates and survival rates were compared between 2 groups. Results After radiotherapy, only 1 case (1.15%) had HBV reactivation in ETV group, while 12 cases (29.27%) in non-ETV group. There was a significant difference between 2 groups (P=0.000). A total of 51 patients had hepatotoxicity, 26 (29.89%) in ETV group and 25 (60.89%) in non-ETV group. The difference was significant between 2 groups (P=0.008). The median survival time was 19.27±2.53 months (95% confidence interval: 14.305-24.235) and 11.43±5.29 months (95% confidence interval: 1.059-21.801) in ETV group and non-ETV group, respectively. There was no significant difference in the 3-year survival rate between 2 groups (P=0.167).Conclusion In the HBV related HCC patients receiving radiotherapy, ETV works better than other antiviral therapy in the prevention of HBV reactivation and hepatotoxicity. However, there is no difference in the long-term survival benefits of patients with different antiviral treatment.

Key words: Hepatocellular carcinoma, Radiotherapy, Hepatitis B virus, Entecavir, Lamivudine

何雅婧, 张植明, 何伟猛, 侯金林. 不同抗病毒治疗方案在接受放疗的HBV相关性肝细胞癌中的作用[J]. 肝脏, 2019, 24(6): 622-627.

HE Ya-jing, ZHANG Zhi-ming, HE Wei-meng, HOU Jin-lin. Efficacy of different anti-viral therapy regimens for HBV related hepatocellular carcinoma receiving radiotherapy[J]. Chinese Hepatolgy, 2019, 24(6): 622-627.

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