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目的观察抗病毒治疗对乙肝病毒(HBV)感染的肝细胞癌患者根治性手术预后的影响。方法回顾性分析2008年8月至2012年6月期间笔者所在医院科室行肝癌根治性切除术50例患者的临床资料,50例患者HBV-DNA血清浓度大于3 log10 copies/m L纳入本次研究,其中21例患者未行抗病毒治疗(未治疗组),29例患者行核苷酸类似物抗病毒治疗(抗病毒治疗组)。结果抗病毒治疗组患者肝癌根治性切除术后1、3及5年累积无瘤生存率分别为72.4%、58.6%和31.0%,未治疗组患者肝癌根治性切除术后1、3及5年累积无瘤生存率分别为61.9%、38.1%和14.3%;抗病毒治疗组患者肝癌根治性切除术后1、3及5年累积总生存率分别为86.2%、68.9%和55.2%,未治疗组患者肝癌根治性切除术后1、3及5年累积总生存率分别为71.4%、47.6%和28.6%。抗病毒治疗组患者术后的累积无瘤生存率和总生存率均明显高于未治疗组(P<0.05)。单因素分析结果显示:肿瘤数目、抗病毒治疗和TNM分期是影响患者无瘤生存率的危险因素;肿瘤直径、肿瘤数目、抗病毒治疗和TNM分期是影响总生存率的危险因素。多因素分析结果显示:肿瘤数目及TNM分期是影响无瘤生存率的独立危险因素(OR:2.95,95%CI:1.502~6.114,P<0.05;OR:4.12,95%CI:1.972~68.960,P<0.05);抗病毒治疗及TNM分期是影响患者总生存时间的独立危险因素(OR:3.86,95%CI:1.745~7.028,P<0.05;OR:5.17,95%CI:2.356~11.479,P<0.05)。结论使用核苷酸类似物抗病毒治疗可改善乙肝肝癌切除术后患者的预后。
Objective To observe the effect of antiviral therapy on the prognosis of patients with hepatocellular carcinoma (HCC) infected with Hepatitis B virus (HBV). Methods The clinical data of 50 patients undergoing radical resection of liver cancer from August 2008 to June 2012 in our hospital were retrospectively analyzed. The serum HBV-DNA concentrations in 50 patients were more than 3 log10 copies / mL, , Of which 21 patients did not receive antiviral therapy (untreated group) and 29 patients received nucleotide analog anti-viral therapy (antiviral therapy group). Results The cumulative tumor-free survival rates at 1, 3, and 5 years after radical resection of hepatocellular carcinoma in patients with antiviral therapy were 72.4%, 58.6% and 31.0%, respectively, and those in untreated patients were 1,3 and 5 years after radical resection of hepatocellular carcinoma The cumulative tumor-free survival rates were 61.9%, 38.1% and 14.3% respectively. The cumulative 1,3 and 5-year cumulative survival rates after radical resection of hepatocellular carcinoma in the antiviral therapy group were 86.2%, 68.9% and 55.2%, respectively, The cumulative overall survival rates at 1, 3, and 5 years after radical resection of HCC were 71.4%, 47.6% and 28.6%, respectively. The cumulative tumor-free survival rate and overall survival rate of patients in the antiviral therapy group were significantly higher than those in the untreated group (P <0.05). Univariate analysis showed that the number of tumors, antiviral therapy and TNM staging were the risk factors influencing the tumor-free survival rate. The tumor diameter, tumor number, antiviral therapy and TNM stage were the risk factors affecting the overall survival rate. Multivariate analysis showed that the number of tumors and the TNM stage were independent risk factors influencing tumor-free survival (OR: 2.95, 95% CI: 1.502-6.1414, P <0.05; OR: 4.12, 95% CI: 1.972-68.960, (OR: 3.86,95% CI: 1.745 ~ 7.028, P <0.05; OR: 5.17, 95% CI: 2.356 ~ 11.479, P <0.05). The antiviral treatment and TNM staging were independent risk factors affecting the overall survival of patients P <0.05). Conclusion Antiviral treatment with nucleotide analogues can improve the prognosis of patients after hepatectomy.