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目的探讨核苷(酸)类似物在乙型肝炎病毒(HBV)相关肝细胞癌(HCC)经肝动脉介入治疗(TAIT)中的应用价值。方法入组60例HBsAg阳性且不能手术切除的HCC患者,配对分为核苷(酸)类似物治疗组(A组)和常规保肝降酶组(B组),每组30例。对两组进行常规TAIT同时,给予常规保肝降酶治疗,A组同时联合核苷(酸)类药物行抗病毒治疗。比较两组的生存率,分析预后影响因素。结果 A组核苷(酸)类似物抗病毒初始治疗药物选择:恩替卡韦14例,拉米夫定8例,阿德福韦酯8例,其中4例患者出现病毒学突破,经加用另一核苷(酸)类似物后实现病毒持续抑制。B组中,13例(13/30,43.33%)患者分别在第1~9次TAIT后发生病毒学突破,中位突破时间为5.52个月(4次TAIT后)。两组共死亡48例,其中A组20例,B组28例,中位生存期分别为29.63、14.77个月(χ2=7.51,P=0.01)。A组和B组中BCLC分期C期患者中位生存期分别为23.63、8.07个月(2χ=7.11,P=0.01)。Cox回归模型分析显示:患者是否行核苷(酸)类似物抗病毒治疗、肝功能分级、肝癌BCLC分期影响患者预后。未发生核苷(酸)类药物相关严重不良反应。结论采用TAIT治疗HBV相关HCC时联合应用核苷(酸)类药物安全、有效。
Objective To investigate the value of nucleoside (acid) analogues in the treatment of Hepatitis B virus (HBV) -related hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TAIT). Methods A total of 60 HCC patients who were positive for HBsAg and could not be surgically resected were enrolled in this study. The patients were divided into three groups: nucleoside analogue therapy group (A group) and conventional liver protection enzyme group (B group). The two groups were routine TAIT at the same time, given regular liver protection enzyme treatment, A group of nucleoside (acid) drugs simultaneously antiviral therapy. The survival rates of the two groups were compared, and the prognostic factors were analyzed. Results A group of nucleoside (acid) analog anti-virus initial treatment options: entecavir in 14 cases, lamivudine in 8 cases, adefovir dipivoxil in 8 cases, of which 4 cases of virological breakthrough, by adding another Nucleoside (acid) analogues achieve sustained virus suppression. In group B, 13 (13/30, 43.33%) patients developed virological breakthrough after the first to ninth TAITs, respectively, with a median breakthrough time of 5.52 months (after 4 TAITs). There were 48 deaths in both groups, including 20 cases in group A and 28 cases in group B. The median survival time was 29.63 and 14.77 months respectively (χ2 = 7.51, P = 0.01). The median survival in patients with BCLC stage C in group A and group B was 23.63 and 8.07 months respectively (2χ = 7.11, P = 0.01). Cox regression analysis showed that patients underwent antiviral therapy with nucleoside (acid) analogs, liver function grading, and BCLC staging of liver cancer affecting prognosis. Nucleoside (acid) drug-related serious adverse reactions did not occur. Conclusions The combination of TAIT with nucleoside (acid) drugs in the treatment of HBV-related HCC is safe and effective.