Effect of entecavir antiviral therapy on the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after transcatheter arterial chemoembolization
Objective To investigate the effect of entecavir (ETV) antiviral therapy on the prognosis of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) receiving transcatheter arterial chemoembolization (TACE).Methods A total of 170 HCC patients who received TACE for the first time in Liver Cancer Center of Nanfang Hospital from January 2011 to March 2018 were enrolled, among whom 114 patients were treated with ETV (ETV treatment group) and 56 patients did not receive antiviral therapy (control group). Baseline demographic data, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (Alb), platelet count (PLT), Child-Pugh class, HBeAg and HBV DNA levels, alpha-fetoprotein, and BCLC stage were recorded before treatment, and the changes in HBV DNA level, ALT, AST, TBil, Alb, and Child-Pugh class were observed at weeks 4-8 after treatment; long-term survival was also observed after treatment. Short- and long-term clinical benefits (overall survival) were observed for all patients. The t-test or the Mann-Whithey U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Multivariate logistic regression analyses were performed for related clinical indices before treatment to identify the risk factors for HBV reactivation. The Kaplan-Meier method was used to analyze the survival curves of overall survival, and the log-rank test was used for comparison of survival curves.Results There was no significant difference in the incidence rate of HBV reactivation between the ETV treatment group and the control group (15.79% vs 16.07%, χ2=0.002, P=0.962). The univariate analysis showed that PLT was a risk factor for HBV reactivation (Z=-2.183, P=0.029), and the multivariate analysis showed that HBV DNA level was an independent risk factor for HBV reactivation (hazard ratio =1.000, P=0.015). The 1-, 3-, and 5-year survival rates were 56.20%, 30.30%, and 13.20%, respectively, in the ETV treatment group and 60.60%, 27.20%, and 16.30%, respectively, in the control group. There was no significant difference in overall survival rate between the two groups (χ2=0.049, P=0.755).Conclusion Antiviral therapy can inhibit HBV replication after TACE in patients with HBV-related HCC, thereby reducing the hepatotoxicity of TACE.
102例入组患者中，51例为轻度至中度纤维化，51例为进展期肝纤维化及肝硬化。与基线相比，102例患者肝脏硬度值中位数在治疗结束时下降了2.85 kPa，且持续下降至治疗结束后第12周。其中，51例进展期肝纤维化及肝硬化患者肝脏硬度值中位数变化更显著：与基线水平相比，治疗结束时降低了3.6 kPa；同时，与基线相比，102例患者APRI和FIB-4评分的中位数在治疗结束时均显著下降[0.64(0.39~1.21) vs 0.35(0.26~0.52)，P＜0.001; 2.53(1.30~3.91) vs 1.87(0.89~2.5), P＜0.001]，且持续下降至治疗结束后第12周，但与治疗结束时相比，差异无统计学意义；此外，与基线相比，102例患者的血清壳多糖酶3样蛋白1和高尔基体蛋白73水平在治疗结束时均显著降低[134.07(154.49) vs 103.75(98.04)，P=0.025; 98.24(64.76) vs 88.91 (50.89), P=0.002]。
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