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目的探讨核苷(酸)类似物(NAs)治疗与全程管理对乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)术后临床结局的影响。方法病理确诊HBV相关性肝癌术后患者43例,术前血清HBVDNA均≥1000拷贝/mL,肿瘤直径>5cm11例、直径≤5 cm32例;术后接受NAs抗病毒治疗与全程管理。拉米夫定(LAM)治疗7例,阿德福韦酯(ADV)11例,替比夫定(LDT)6例,恩替卡韦(ETV)17例,LAM+ADV1例,ADV+ETV1例。每3个月检测HBV DNA、HBV血清学标志物、肝功能、甲胎蛋白、B超(CT或MRI),观察随访至临床终点事件(肝癌术后复发、死亡)的发生或达最后访视日期。寿命表法计算病毒学突破、临床结局(肝癌术后复发、死亡)的年发生率及累积发生率。结果 43例患者平均随访2.5年(6个月—8年)。(1)全程管理过程中11.63%(5/43)患者发生病毒学突破,1、3、5年累计发生率分别为:5%,12.17%,22.51%,经挽救治疗后,均在3个月内HBV DNA阴转。(2)最后访视日期时90.7%(39/43)患者HBV DNA低于检测下限(<1000拷贝/mL),ALT均值39 U/L。(3)肝癌复发5例(其中4例复发时发生病毒学突破),1年内复发1例,1-2年内复发4例,年复发率4.8%,1、3、5年累计复发率分别为2.5%、14.5%、14.5%。(4)3例死亡,其中1例死于肝癌复发,2例死于上消化道大出血,年病死率2.8%,1、3、5年生存率分别为97.5%、90.4%、90.4%。结论 NAs抗病毒治疗与全程管理可降低HBV相关性肝癌术后肝癌复发率,延长生存期。
Objective To investigate the effect of nucleoside analogue (NAs) treatment and total management on the postoperative clinical outcome of patients with hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV). Methods Forty-three postoperative patients with HBV-related hepatocellular carcinoma (HCC) were confirmed by pathology. Preoperative serum HBVDNA was ≥1000 copies / mL. Tumor diameter was> 5cm in 11 cases and diameter≤5cm in 32 cases. Postoperative NAs antiviral therapy and full management were performed. Seven patients were treated with lamivudine (LAM), 11 were adefovir dipivoxil (ADV), 6 were telbivudine (LDT), 17 were entecavir (ETV), 1 was LAM + ADV and 1 was ADV + ETV. HBV DNA, HBV serological markers, liver function, alpha-fetoprotein and B-ultrasound (CT or MRI) were detected every 3 months. The follow-up to the clinical end point (recurrence and death of liver cancer) was observed or the last visit date. Life table method to calculate the virological breakthrough, the clinical outcome (recurrence of liver cancer, death) the annual incidence and cumulative incidence. Results 43 patients were followed up for an average of 2.5 years (6 months to 8 years). (1) Virological breakthrough occurred in 11.63% (5/43) of the patients in the whole course of management. The cumulative incidences in 1, 3 and 5 years were 5%, 12.17% and 22.51% respectively. After salvage treatment, HBV DNA overcast during the month. (2) The HBV DNA of 90.7% (39/43) patients at the last visit was lower than the lower limit of detection (<1000 copies / mL), and the mean ALT was 39 U / L. (3) 5 cases of recurrent hepatocellular carcinoma (4 of them recurred virologically), 1 case recurred within 1 year, 4 cases recurred within 1 to 2 years, the annual recurrence rate was 4.8%, and the cumulative recurrent rates at 1, 3 and 5 years were 2.5%, 14.5%, 14.5%. (4) 3 died, 1 died of recurrence of liver cancer, 2 died of upper gastrointestinal bleeding, the annual mortality rate of 2.8%, 1,3,5-year survival rates were 97.5%, 90.4%, 90.4%. Conclusion NAs antiviral therapy and full management can reduce the recurrence rate and prolong the survival of hepatocellular carcinoma after HBV-related liver cancer.