Interferon-based treatment is superior to nucleos(t)ide analog in reducing HBV-related hepatocellular carcinoma for chronic hepatitis B patients at high risk
Interferon-based treatment is superior to nucleos(t)ide analog in reducing HBV-related hepatocellular carcinoma for chronic hepatitis B patients at high risk
复制标题
对于高危慢性乙型肝炎患者，基于干扰素的治疗在减少乙型肝炎相关肝细胞癌方面优于核苷类似物
DOI：
10.1080/14712598.2018.1518423
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发表时间：
2018-01-01
影响因子：
4.6
通讯作者：
Xie, Qing
中科院分区：
文献类型：
--
作者：
Ren, Peipei;Cao, Zhujun;Xie, Qing
摘要背景：核苷（酸）类似物（NAs）与干扰素（IFN）对慢性B型肝炎（CH B）患者肝细胞癌（HCC）发生的影响存在争议。我们评估了抗病毒策略是否影响不同HCC风险的CHB患者的HCC发展。方法：对1112例接受抗病毒治疗的慢性乙型肝炎患者进行回顾性研究。其中NAs组682例，IFN组430例。应用倾向评分匹配（PSM）以最小化基线差异。结果：共有31例患者在随访期间（中位数5.41年）发生了肝癌。IFN组10年累积HCC发病率显著低于NAs组（2.7% vs 8.0%，p < 0.001）。在PSM队列中获得了类似的结果。与NAs患者相比，接受基于IFN治疗的患者发生HCC的可能性较小（风险比= 0.15; 95% CI 0.04-0.66; p = 0.012）。亚组分析表明，干扰素在减少肝癌发展方面的优势在肝癌高危患者中是明显的，但在低危患者中不是。结论：在HCC风险较高的CHB患者中，IFN治疗比NAs治疗更能显著减少HCC的发生。
ABSTRACT Background: The effect of nucleos(t)ide analogs (NAs) versus interferon (IFN) on the occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) is controversial. We assessed whether antiviral strategy affected HCC development in CHB patients at different HCC risks. Methods: 1112 CHB patients with antiviral therapy were included in this retrospective study. Patients treated with NAs only were classified into NAs group (n = 682) while those received IFN treatment with or without NAs were defined as IFN group (n = 430). Propensity score matching (PSM) was applied to minimize baseline differences. Results: Totally, 31 patients developed HCC during follow-up (median 5.41 years). The cumulative HCC incidence at 10 years was significantly lower in the IFN group than NAs group (2.7% vs 8.0%, p < 0.001). Similar results were obtained in the PSM-cohort. Patients with IFN-based treatment were less likely to develop HCC than those with NAs (Hazard ratio = 0.15; 95% CI 0.04–0.66; p = 0.012). Subgroup analyses demonstrated that this superiority of IFN in reducing HCC development was obvious in patients at high- but not low-risk of HCC. Conclusions: Reduction of HCC development was more significant in CHB patients at higher HCC risk with IFN-based therapy than NAs treatment.