Temporal improvement in survival of patients with hepatocellular carcinoma in a hepatitis B virus-endemic population
Temporal improvement in survival of patients with hepatocellular carcinoma in a hepatitis B virus-endemic population
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DOI：
10.1111/jgh.13848
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发表时间：
2018-02-01
影响因子：
4.1
通讯作者：
Hwang, Jae Seok
中科院分区：
文献类型：
--
作者：
Kim, Bo Hyun;Lim, Young-Suk;Hwang, Jae Seok
背景和目的：在过去的十年中，肝细胞癌（HCC）和病毒性肝炎的治疗得到了改善。我们探讨了B型肝炎病毒（HBV）流行人群中HCC的生存趋势和影响生存的因素。在2003-2005年和2008-2010年期间，我们分别从31521和38167名HCC登记者中随机抽取了4515和4582名患者，结果：与2003-2005年队列相比，2008-2010年队列的肝功能明显改善（Child-Turcotte-Pugh A级，64.2%比71.6%; P < 0.001），并且具有更晚期的肿瘤分期（巴塞罗那诊所肝癌B-D期，45.8% vs 50.4%; P < 0.001）。HBV是两个队列中HCC的主要原因（62.5% vs 62.2%; P = 0.70）。通过年龄调整的单变量、多变量和倾向评分匹配分析，队列2008-2010的总生存期显著优于队列2003-2005（中位生存时间，17.2 vs 28.4个月; P < 0.001）。在亚队列分析中，只有HBV相关HCC患者的队列间生存率持续显著改善（中位生存期，16.1 vs 30.4个月; P < 0.001）。每年接受口服抗病毒药物治疗HBV的HCC患者数量从2005年的93例急剧增加到2010年的28520例，在national.Conclusions：HCC患者生存率的持续改善仅限于HBV相关的HCC亚队列在过去十年中的HBV流行人群。生存率的提高与患者口服抗HBV药物的指数使用相一致。
Background and Aim: Over the past decade, the management of hepatocellular carcinoma (HCC) and viral hepatitis has been improved. We explored survival trends and factors affecting survival of HCC in a hepatitis B virus (HBV)-endemic population.Methods: From 31521 and 38167 HCC registrants to the population-based national cancer registry in Korea, an HBV-endemic country, in the period of 2003-2005 and 2008-2010, we randomly sampled cohorts of 4515 and 4582 patients, respectively, for the investigation of clinical characteristics and survival.Results: Compared with Cohort 2003-2005, Cohort 2008-2010 had significantly better liver function (Child-Turcotte-Pugh class A, 64.2% vs 71.6%; P < 0.001) and had more advanced tumor stages (Barcelona Clinic Liver Cancer stage B-D, 45.8% vs 50.4%; P < 0.001). HBV was the predominant cause of HCC in both cohorts (62.5% vs 62.2%; P = 0.70). Cohort 2008-2010 had significantly better overall survival than Cohort 2003-2005 by age-adjusted univariate, multivariable, and propensity score-matched analyses (median survival time, 17.2 vs 28.4 months; P < 0.001). In a subcohort analysis, a consistently significant inter-cohort improvement in survival was observed only in patients with HBV-related HCC (median survival, 16.1 vs 30.4 months; P < 0.001). The annual number of patients with HCC receiving oral antiviral agents for HBV precipitously increased from 93 in 2005 to 28520 in 2010 in the country.Conclusions: The consistent improvement in survival of patients with HCC was confined to HBV-related HCC subcohort over the last decade in an HBV-endemic population. The survival improvement coincided with the exponential use of oral antiviral agents for HBV in the patients.