Increasing Burden of Liver Cancer Despite Extensive Use of Antiviral Agents in a Hepatitis B Virus-Endemic Population
Increasing Burden of Liver Cancer Despite Extensive Use of Antiviral Agents in a Hepatitis B Virus-Endemic Population
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DOI：
10.1002/hep.29321
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发表时间：
2017-11-01
期刊：
影响因子：
13.5
通讯作者：
Lim, Young-Suk
中科院分区：
文献类型：
--
作者：
Choi, Jonggi;Han, Seungbong;Lim, Young-Suk
全世界大多数肝病和肝癌的死亡可归因于乙型肝炎病毒（HBV）和丙型肝炎病毒。尽管在过去的几十年里，HBV的治疗取得了显著的进展，但关于其对肝脏疾病和肝癌负担的影响，人口水平的数据有限。1999年至2013年，从hbv流行国家韩国的国家死亡证明数据库中获取肝病和肝癌死亡率数据，并通过Joinpoint分析进行分析。对于肝病，1999年至2013年间，年死亡人数下降了62.3%(95%置信区间[CI]， 62.0-62.6)，粗死亡率（CDR）下降了64.6% (95% CI, 64.3-64.9)，从每10万人21.2人下降到7.5人，年龄标准化死亡率（ADR）下降了75.0% （95% CI, 74.7-75.3）。相比之下，肝癌的年死亡人数增加了17.8% (95% CI, 17.6-18.0)， CDR增加了10.2% (95% CI, 10.0-10.4)，从20.5例增加到22.6例，尽管ADR减少了26.9% （95% CI, 26.6-27.2）。在研究期间，每年接受口服HBV抗病毒药物治疗的患者人数从1716人增加到187226人。肝病患者平均死亡年龄的增加明显大于肝癌患者（8.8岁vs. 6.1岁：P = 0.02）。结论：广泛使用抗病毒治疗HBV可显著降低肝病死亡率，这可能会增加预期寿命和患肝癌风险的患者数量，无意中导致HBV流行人群中肝癌负担的增加。在制定卫生保健政策时，应仔细考虑肝病死亡与肝癌死亡之间的竞争性质。
Most mortalities from liver disease and liver cancer worldwide are attributable to hepatitis B virus (HBV) and hepatitis C virus. Despite remarkable advances in the treatment of HBV over past decades, limited population-level data are available regarding its impact on burden of liver disease and liver cancer. Mortality data from liver disease and liver cancer were obtained from the national death certificate database of Korea, an HBV-endemic country, between 1999 and 2013, and were analyzed by Joinpoint analysis. For liver disease, number of annual deaths decreased by 62.3% (95% confidence interval [CI], 62.0-62.6), crude death rate (CDR) decreased by 64.6% (95% CI, 64.3-64.9) from 21.2 to 7.5 per 100,000 population, and age-standardized death rate (ADR) declined by 75.0% (95% CI, 74.7-75.3), between 1999 and 2013. In contrast, for liver cancer, number of annual deaths increased by 17.8% (95% CI, 17.6-18.0) and CDR increased by 10.2% (95% CI, 10.0-10.4) from 20.5 to 22.6, although ADR decreased by 26.9% (95% CI, 26.6-27.2). The annual number of patients receiving oral antiviral agents against HBV increased from 1,716 to 187,226 during the study period. The increase in mean age at death from liver disease was significantly greater than that from liver cancer (8.8 vs. 6.1 years: P = 0.02). Conclusion: Marked reduction in liver disease mortality by widespread use of antiviral treatments against HBV may increase the life expectancy and number of patients at risk of developing liver cancer, inadvertently leading to increased burden of liver cancer in an HBV-endemic population. The competing nature between death from liver disease and that from liver cancer should be carefully considered in establishing a health care policy.