Sorafenib use in hepatitis B virus- or hepatitis C virus-related hepatocellular carcinoma: A propensity score matching study
Sorafenib use in hepatitis B virus- or hepatitis C virus-related hepatocellular carcinoma: A propensity score matching study
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DOI：
10.1002/kjm2.12413
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发表时间：
2021-06-24
影响因子：
3.3
通讯作者：
Kuo, Yuan-Hung
中科院分区：
文献类型：
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作者：
Lee, Yu-Chi;Wang, Jing-Houng;Kuo, Yuan-Hung
索拉非尼是晚期肝细胞癌（HCC）患者的推荐一线治疗选择。在索拉非尼的使用中，丙型肝炎病毒（HCV）相关的晚期HCC（HCV-HCC）似乎比B肝炎病毒（HBV）相关的HCC（HBV-HCC）有更好的反应，但尚未确定。因此，我们的目的是研究索拉非尼对台湾HBV-HCC和HCV-HCC患者的影响。2012年8月至2016年12月，我院连续575例晚期HCC患者接受台湾全民健康保险报销的索拉非尼治疗。每隔2个月进行一次放射学评估。肿瘤进展或肝功能恶化的患者不允许进一步使用索拉非尼。回顾性入组HBV或HCV感染患者，并随访至2018年12月。其中HBV-HCC患者277例（62.4%），HCV-HCC患者167例（37.6%）。在索拉非尼治疗前，192例（69.3%）HBV-HCC患者使用核苷类似物（NAs）进行HBV管理，而只有5例（3%）HCV-HCC患者接受了基于干扰素的抗病毒治疗。HCV-HCC患者的总生存期（OS）显著上级于无NAs的HBV-HCC患者（8.8个月vs. 4.9个月，p = 0.006），但不劣于有NAs的HBV-HCC患者（8.8个月vs. 10.7个月，p = 0.54）。使用倾向评分匹配，HBV-HCC和HCV-HCC组之间的无进展生存期（2.0个月vs. 2.1个月，p = 0.374）和OS（10.5个月vs. 9.6个月，p = 0.746）没有差异。抗病毒治疗可能增加接受索拉非尼治疗的晚期HBV-HCC患者的生存获益，导致台湾HCV-HCC患者的OS相当。
Sorafenib is the recommended first-line treatment option for patients with advanced hepatocellular carcinoma (HCC). Hepatitis C virus (HCV)-related advanced HCC (HCV-HCC) seemed to have a better response than hepatitis B virus (HBV)-related HCC (HBV-HCC) in sorafenib use, but it was undetermined. Hence, we aimed to investigate the effect of sorafenib between HBV-HCC and HCV-HCC patients in Taiwan. From August 2012 to December 2016, 575 consecutive advanced HCC patients received sorafenib under the reimbursement of Taiwan national health insurance in our hospital. Radiologic assessment was performed at a 2-month interval. Those patients with tumor progression or liver function deterioration were disallowed for further sorafenib use. Patients with HBV or HCV infection were, retrospectively, enrolled and followed till December 2018. There were 277 (62.4%) HBV-HCC patients and 167 (37.6%) HCV-HCC patients. Before sorafenib, 192 (69.3%) HBV-HCC patients who had used nucleoside analogs (NAs) for HBV management, whereas only 5 (3%) HCV-HCC patients received interferon-based antiviral therapy. Overall survival (OS) of HCV-HCC patients was significantly superior to HBV-HCC patients without NAs (8.8 months vs. 4.9 months, p = 0.006), but was noninferior to HBV-HCC patients with NAs (8.8 months vs. 10.7 months, p = 0.54). Using propensity score matching, progression-free survival (2.0 months vs. 2.1 months, p = 0.374) and OS (10.5 months vs. 9.6 months, p = 0.746) between HBV-HCC and HCV-HCC groups were not different. Antiviral therapy might increase survival benefits of advanced HBV-HCC patients underwent sorafenib use, leading to a comparable OS to HCV-HCC patients in Taiwan.