核苷类似物联合TACE治疗HBV相关性肝细胞癌的预后分析

张秋明; 钟鉴宏; 游雪梅; 马良; 向邦德; 朱少亮; 龚文锋; 黎乐群

doi:10.3971/j.issn.1000-8578.2016.09.013

核苷类似物联合TACE治疗HBV相关性肝细胞癌的预后分析

Prognosis of HBV-related Hepatocellular Carcinoma Patients Treated with Nucleos(t)ide Analogue Therapy Combined with Transarterial Chemoembolization

摘要

摘要:
目的比较肝切除术后核苷类似物联合经肝动脉化疗栓塞（TACE）与单用TACE治疗对提高乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）患者总生存率的效果。
方法回顾性分析345例行肝切除术的HBV相关性HCC患者资料，其中术后接受核苷类似物抗病毒联合TACE治疗者89例（观察组），术后单用TACE治疗者256例（对照组）。采用倾向性匹配法均衡组间混杂因素的影响。
结果观察组的90天死亡率（2.2%）稍低于对照组（3.1%, P=0.672）。同时，观察组患者的1、3、5年累积总生存率显著高于对照组，分别为93%、66%、45%和90%、54%、36%（P=0.014）。倾向性分析显示，观察组患者的1、3、5年累积总生存率为93%、67%和45%，亦显著高于对照组患者的87%、46%和24%（P＜0.001）。基于肿瘤分期的亚组分析显示，巴塞罗那临床肝癌分期A/B期的患者中，观察组患者的累积总生存率显著优于对照组（P=0.011）。
结论 HBV相关性HCC肝切除术后核苷类似物联合TACE治疗有利于降低存在高危复发因素且术前HBV DNA≥103 IU/ml患者围手术期死亡率并提高其总生存率。

Abstract:
Objective To investigate the efficacy of nucleos(t)ide analogue (NAs) plus transarterial chemoembolization (TACE) on the overall survival of the patients with postoperative hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
Methods We retrospectively analyzed a total of 345 patients with HBV-related HCC and the risk factors of recurrence. Among them, 89 patients received NAs plus TACE therapy, while other 256 patients received adjuvant TACE therapy alone. Propensity-score matching analysis was used to balance the bias between groups.
Results The 90-day mortality of the combination therapy group was slightly lower than that of the adjuvant TACE group (2.2% vs. 3.1%, P=0.672). The 1-, 3-, and 5-year overall survival were significantly higher in the combination therapy group than those in the adjuvant TACE group (93%, 66%, 45% vs. 90%, 54%, 36%, P=0.014). Moreover, the combination therapy group also had significantly higher overall survival than the adjuvant TACE group after propensity-score analysis (93%, 67%, 45% vs. 87%, 46%, 24%, P＜0.001). However, the subgroup analysis based on tumor stage revealed that the combination therapy group had significantly higher overall survival than the adjuvant TACE group of those with BCLC-A/B HCC.
Conclusion Postoperative NAs plus TACE treatment modality is effective in reducing the perioperative mortality and improving the overall survival of HBV-related HCC patients with preoperative HBV DNA≥103 IU/ml and the risk factors of recurrence.

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