JAMA Surg:肝切除前抗病毒治疗能降低早期复发风险?

2018-08-27 吴星 环球医学

2018年8月,发表在《JAMA Surg》的一项由中国和美国学者进行的研究,考察了术前抗病毒治疗(AVT)与乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)肝切除术后的早期复发、微血管侵犯之间的相关性。

2018年8月,发表在《JAMA Surg》的一项由中国和美国学者进行的研究,考察了术前抗病毒治疗(AVT)与乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)肝切除术后的早期复发、微血管侵犯之间的相关性。

重要性:乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)患者微血管侵犯(MVI)的发病率降低,或与早期肿瘤复发风险降低和部分肝切除后生存的更好相关。

目的:考察HBV相关HCC患者术前抗病毒治疗(AVT)与MVI发病以及肝切除后早期肿瘤复发之间的相关性。

设计、地点和受试者:评价中国上海第二军医大学东方肝胆外科医院2008年1月至2010年4月因为HBV相关HCC行R0切除术的2362患者队列的相关数据。中位(四分位间距)术后随访时间为44.8(22.8至59.3)个月。2016年6月至2017年10月,分析数据。

干预:术后AVT和部分肝切除。

主要结局和测量指标:使用Kaplan-Meier法、log-rank检验,以及Cox回归分析,计算并比较术后总生存以及复发时间。通过logistic回归分析,评价MVI发生的独立风险因素。

结果:在纳入的2362例患者中,1999例(84.6%)为男性,中位(四分位间距)年龄为50.6(43.1~57.3)岁。共2036例患者(86.2%)没有使用任何AVT,而326例(13.8%)患者在术前90多天使用AVT治疗。在非AVT组,与术前HBV DNA水平低于2000 IU/mL相比,≥2000 IU/mL与MVI风险增加相关(比值比[OR],1.399;95%置信区间[CI],1.151~1.701)。与非AVT组相比,AVT组患者的MVI发病率较低(38.7% [326例中126例] vs 48.6% [2036例中989例];P=0.001),且MVI风险降低(OR,0.758;95% CI,0.575~0.998)。AVT完全应答是MVI的一个独立预测因素(OR,0.690;95% CI,0.500~0.952)。因此,与非AVT相比,术前AVT与6个月、1年,以及2年复发率降低相关(分别为14.2%、24.6%和38.5% vs 23.4%、37.1%和52.3%;P<0.001)。AVT可以预防早期肿瘤复发(风险比[HR],0.732;95% CI,0.605~0.886)。此外,与使用AVT的患者相比,非AVT组患者更可能发生多个肝内复发(49.1% [549/1119] vs 36.2% [54/149];P=0.003),复发涉及多个肝分段。

结论和意义:术前HBV DNA水平较高是MVI的一个独立风险因素。术前至少90天进行抗病毒治疗与HBV相关HCC部分肝切除术后MVI发病率降低以及早期肿瘤复发降低相关。

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    2019-08-12 changfy
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    2018-08-31 太阳系小猪

    哎哟,不错哟,术前抗病毒治疗是一个有效的预防术后复发的因素呢。

    0

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    2018-08-29 yahu
  6. [GetPortalCommentsPageByObjectIdResponse(id=1905510, encodeId=730b19055108e, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Mon Sep 17 14:02:00 CST 2018, time=2018-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926404, encodeId=253719264041d, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Mon Aug 12 03:02:00 CST 2019, time=2019-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1756988, encodeId=8cae1e56988c3, content=<a href='/topic/show?id=929f5936375' target=_blank style='color:#2F92EE;'>#早期复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59363, encryptionId=929f5936375, topicName=早期复发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5bd37287806, createdName=124985dbm18(暂无昵称), createdTime=Wed Oct 24 04:02:00 CST 2018, time=2018-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341906, encodeId=c4a23419060b, content=哎哟,不错哟,术前抗病毒治疗是一个有效的预防术后复发的因素呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7e71713450, createdName=太阳系小猪, createdTime=Fri Aug 31 07:05:57 CST 2018, time=2018-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1292452, encodeId=a8901292452ee, content=<a href='/topic/show?id=a3b4554e19d' target=_blank style='color:#2F92EE;'>#抗病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55471, encryptionId=a3b4554e19d, topicName=抗病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52c7237, createdName=yahu, createdTime=Wed Aug 29 06:02:00 CST 2018, time=2018-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1292856, encodeId=dc7112928566a, content=<a href='/topic/show?id=9d23554e95a' target=_blank style='color:#2F92EE;'>#抗病毒治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55479, encryptionId=9d23554e95a, topicName=抗病毒治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ce4238, createdName=dangious, createdTime=Wed Aug 29 06:02:00 CST 2018, time=2018-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341490, encodeId=9176341490f6, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Tue Aug 28 18:01:22 CST 2018, time=2018-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341328, encodeId=9b23341328e8, content=太牛了,这个idea 很有创意, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Mon Aug 27 16:50:51 CST 2018, time=2018-08-27, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1905510, encodeId=730b19055108e, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Mon Sep 17 14:02:00 CST 2018, time=2018-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926404, encodeId=253719264041d, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Mon Aug 12 03:02:00 CST 2019, time=2019-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1756988, encodeId=8cae1e56988c3, content=<a href='/topic/show?id=929f5936375' target=_blank style='color:#2F92EE;'>#早期复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59363, encryptionId=929f5936375, topicName=早期复发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5bd37287806, createdName=124985dbm18(暂无昵称), createdTime=Wed Oct 24 04:02:00 CST 2018, time=2018-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341906, encodeId=c4a23419060b, content=哎哟,不错哟,术前抗病毒治疗是一个有效的预防术后复发的因素呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7e71713450, createdName=太阳系小猪, createdTime=Fri Aug 31 07:05:57 CST 2018, time=2018-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1292452, encodeId=a8901292452ee, content=<a href='/topic/show?id=a3b4554e19d' target=_blank style='color:#2F92EE;'>#抗病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55471, encryptionId=a3b4554e19d, topicName=抗病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52c7237, createdName=yahu, createdTime=Wed Aug 29 06:02:00 CST 2018, time=2018-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1292856, encodeId=dc7112928566a, content=<a href='/topic/show?id=9d23554e95a' target=_blank style='color:#2F92EE;'>#抗病毒治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55479, encryptionId=9d23554e95a, topicName=抗病毒治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ce4238, createdName=dangious, createdTime=Wed Aug 29 06:02:00 CST 2018, time=2018-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341490, encodeId=9176341490f6, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Tue Aug 28 18:01:22 CST 2018, time=2018-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341328, encodeId=9b23341328e8, content=太牛了,这个idea 很有创意, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aadd1680584, createdName=蔬菜, createdTime=Mon Aug 27 16:50:51 CST 2018, time=2018-08-27, status=1, ipAttribution=)]
    2018-08-28 cscdliu

    学习了,谢谢

    0

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    2018-08-27 蔬菜

    太牛了,这个idea 很有创意

    0