抗病毒疗法对慢性乙肝合并肝癌手术后复发患者生存状况的影响

Effect of antiviral therapy on survival status of patients with postoperative recurrence of liver cancer complicated with chronic hepatitis B

摘要:

目的  探讨抗病毒疗法对慢性乙肝合并肝癌手术后复发患者的应用价值。方法  选取2008年1月-2012年12月四川省自贡市中医医院接受手术治疗的44例给予正规抗病毒治疗的慢性乙肝合并肝癌术后复发患者为研究对象，纳入观察组；根据1:1配对原则，选取同期44例未给予正规抗病毒治疗的患者为对照组。比较两组复发后6个月的相关指标，采用Kaplan-Meier法计算两组及各亚组的1、2及3年生存率，并用Log-rank检验进行比较。采用多因素Cox比例风险模型分析影响患者2年生存率的影响因素。结果  复发6个月后，观察组的HBV-DNA水平、HBe-Ag阳性率及AFP水平均显著低于对照组，差异有统计学意义（P < 0.05）。观察组和对照组的中位总生存期分别为21.2个月和14.8个月，观察组的1、2及3年总生存率均显著大于对照组（P <0.05）。TACE亚组中，观察组的2及3年生存率显著高于对照组（P <0.05）。多因素Cox比例风险模型分析结果表明，抗病毒治疗、原发肿瘤的组织学分化以及复发时已有肝硬化是影响患者预后的独立影响因素（P <0.05）。结论  对于有抗病毒治疗指征的肝癌术后复发患者而言，正规的抗病毒治疗可显著降低其HBV-DNA水平，改善其预后，值得临床推广应用。

Abstract:

Objective To investigate the effect of antiviral therapy on survival status in patients with postoperative recurrence of liver cancer complicated with chronic hepatitis B. Methods Forty-four patients with postoperative recurrence of liver cancer complicated with chronic hepatitis B who were given regular antiviral therapy from January 2008 to December 2012 were enrolled for the study as the observation group. In accordance with 1:1 matching principle, other 44 cases who were not given regular antiviral therapy at the same time were selected as control group. Relevant indicators 6 months after recurrence were compared between the two groups. Kaplan-Meier method was used to calculate 1-year, 2-year and 3-year survival rates of the two groups and each sub-group, and Log-rank test was performed to compare them. Multivariate Cox proportional hazard regression model was used to analyze the related factors of 2-year survival rate. Results HBV-DNA level, positive rate of HBeAg and AFP level of the observation group were significantly lower than those of the control group 6 months after recurrence (P < 0.05). The median overall survival of the observation group and control group was 21.2 months and 14.8 months respectively. The 1-year, 2-year and 3-year survival rates of the observation group were significantly higher than those of the control group (P < 0.05). In the sub-group of TACE, the 2-year and 3-year survival rates of the observation group were significantly higher than those of the control group (P < 0.05). The result of multivariate Cox proportional hazard regression model showed that antiviral therapy, primary tumor differentiation, liver cirrhosis at recurrence were the independent related factors affecting the prognosis (P < 0.05). Conclusions For patients with postoperative recurrence of liver cancer who have the antiviral treatment indications, formal antiviral therapy could significantly reduce HBV-DNA level and improve the prognosis, which is worthy of clinical popularization and application.