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目的确定乙型肝炎病毒(HBV)DNA水平与经动脉化疗栓塞治疗(TACE)的肝细胞癌病人生存期之间的关系。材料与方法本研究经机构审查委员会批准,并免除病人知情同意书。连续纳入2005年1月—2007年3月间的183例HBV源性肝细胞癌病人。入组病人均行TACE治疗,但未接受抗病毒治疗。所有病人均在行TACE治疗前检测血清HBV DNA水平,计算其从入组当天至死亡时的总体生存期。借助于独立的影像学评估,应用改良实体肿瘤反应评价标准评估肿瘤进展。结果总体生存期的中位数为19个月(95%CI:13.7~24.3),疾病进展时间的中位数为4个月(95%CI:3.03~4.97)。多因素分析显示,TACE术前的HBV DNA血浆水平高(>2000IU/L)是降低总体生存期[P=0.021;风险比(HR),1.725]、癌症进展-相关高死亡率(P=0.014;HR,1.936)及癌症进展所致肝衰竭相关死亡率(P=0.005,HR,3.908)的独立危险因素。TACE术前HBV DNA水平对非癌症进展所致肝衰竭相关死亡率无显著影响。结论 TACE术前的HBV DNA血浆水平高与TACE术后较差的总体生存期和肝细胞癌的快速进展相关,病人死于癌症的快速进展而非肝炎的恶化。
Objective To determine the relationship between hepatitis B virus (HBV) DNA levels and survival of hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (TACE). Materials and Methods The study was approved by the Institutional Review Board and released from patients’ informed consent. A total of 183 patients with HBV-derived hepatocellular carcinoma (HCC) were recruited from January 2005 to March 2007. All patients underwent TACE treatment, but did not receive antiviral therapy. All patients were tested for serum HBV DNA before TACE treatment and their overall survival was calculated from the day of enrollment to death. Tumor progression was assessed using a modified solid tumor response evaluation criteria with the aid of an independent imaging assessment. Results The median overall survival was 19 months (95% CI: 13.7-24.3) with a median disease progression of 4 months (95% CI: 3.03-4.97). Multivariate analysis showed that high HBV DNA plasma levels (> 2000 IU / L) before TACE were associated with lower overall survival (P = 0.021; risk ratio (HR), 1.725], cancer progression-associated high mortality (P = 0.014 ; HR, 1.936) and independent risk factors for liver failure-related mortality (P = 0.005, HR, 3.908) due to cancer progression. Pre-TACE preoperative HBV DNA levels had no significant effect on the incidence of liver failure-related deaths due to non-cancer progression. Conclusions High pre-TACE HBV DNA plasma levels correlate with poorer overall survival after TACE and rapid progression of hepatocellular carcinoma, with the patient dying from the rapid progression of cancer rather than the worsening of hepatitis.