Peg-interferon and nucleos(t)ide analogue combination at inception of antiviral therapy improves both anti-HBV efficacy and long-term survival among HBV DNA-positive hepatocellular carcinoma patients after hepatectomy/ablation
Peg-interferon and nucleos(t)ide analogue combination at inception of antiviral therapy improves both anti-HBV efficacy and long-term survival among HBV DNA-positive hepatocellular carcinoma patients after hepatectomy/ablation
复制标题
抗病毒治疗开始时聚乙二醇干扰素和核苷类似物联合治疗可提高 HBV DNA 阳性肝细胞癌患者肝切除/消融后的抗 HBV 疗效和长期生存率
DOI：
10.1111/jvh.13236
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发表时间：
2019-12-11
影响因子：
2.5
通讯作者：
Wang, Jiangbin
中科院分区：
文献类型：
--
作者：
Qi, Wenqian;Zhang, Qian;Wang, Jiangbin
抗病毒治疗可改善乙肝病毒DNA阳性肝细胞癌根治性治疗后的预后，但抗病毒治疗尚需进一步优化。本研究旨在评价不同抗病毒策略对肝切除/消融术后肝细胞癌患者的疗效。这项前瞻性、随机、对照和多中心试验纳入了2007年1月至2009年1月肝切除/消融术后HBVDNA阳性的原发性肝癌患者。患者被分成四组：早期联合(恩替卡韦联合Peg-干扰素α-2a治疗1年)、晚期联合治疗(在恩替卡韦治疗1年后加用Peg-干扰素α-2a持续48周)、核素(T)类似物[NA]单一治疗和非抗病毒治疗。主要终点包括无复发存活期和总存活率。共有447名患者入选。早期联合治疗组的2年和8年无复发生存率以及8年总生存率显著高于其他两组抗病毒药物组(P<；0.05)。治疗48周后，早期联合治疗组有更多患者的乙肝表面抗原下降，平均水平低于晚期联合治疗组和NA单药治疗组(P<；0.05)。多变量分析显示，早期联合治疗和治疗48周后乙肝表面抗原降低1500IU/ml与降低死亡率和疾病复发有关。对于肝切除/消融术后HBVDNA阳性的肝细胞癌患者，早期采用联合抗病毒治疗可能是一种更有效的治疗策略。在48周的治疗后，乙肝表面抗原降低1500IU/ml与降低HBVDNA阳性肝细胞癌患者在肝切除/消融后的死亡率和疾病复发有关。
Antiviral therapy has been shown to improve the prognosis of hepatitis B virus (HBV) DNA-positive hepatocellular carcinoma (HCC) after radical treatment, but antiviral treatments require further optimization. This study aimed to evaluate the efficacies of different antiviral strategies with HCC patients after hepatectomy/ablation. This prospective, randomized, controlled and multi-centre trial enrolled HBV DNA-positive primary HCC patients after hepatectomy/ablation between January 2007 and January 2009. Patients were divided into four groups: early combination (entecavir plus Peg-interferon [IFN]alpha-2a co-administration during year 1); late combination (addition of Peg-IFN alpha-2a for 48 weeks after 1 year of entecavir); nucleos(t)ide analogue[NA] monotherapy; and non-antiviral treatment. Primary endpoints included recurrence-free survival and overall survival. A total of 447 patients were enrolled. The 2-year and 8-year recurrence-free survival and 8-year overall survival rates were significantly higher in the early combination group than in the other two antiviral groups (P < .05). After 48-week treatment, more patients achieved an HBsAg reduction >1500 IU/mL and the mean HBsAg level was significantly lower in the early combination group compared with the late combination and NA monotherapy groups (P < .05). Multivariate analysis showed that early combination therapy and a reduction in HBsAg by >1500 IU/mL after 48 weeks of therapy correlated with reduced mortality and disease recurrence. Early introduction of combination antiviral treatment may represent a more effective therapeutic strategy for patients with HBV DNA-positive HCC after hepatectomy/ablation. A reduction in HBsAg by >1500 IU/mL after 48-week treatment is associated with reduced mortality and disease recurrence of HBV DNA-positive HCC patients after hepatectomy/ablation.