乙肝复发和/或肝细胞癌复发仍然是乙肝病毒相关性肝细胞癌患者进行肝移植后关注的一个重点。这个研究调查了HBV复发和肝细胞癌复发的关联并探讨了影响肝移植患者预后的因素。在2002年9月至2009年8月期间，78名进行肝移植后的乙肝病毒相关性肝细胞癌患者加入到这项研究中。患者肝移植前留取血清样本，进行HBV DNA相关病毒学检测及病毒基因型特性检测。通过单变量和多变量分析方法进一步评估所有患者的临床病理及病毒学因素以明确预后因素。平均随访29.4个月后，13 名患者(16.6 %) 出现肝细胞癌复发，18 名患者(23.1 %)出现HBV复发。HBV复发与肝细胞癌复发明显相关联（P=0.004）并且明显降低肝移植后存活率。预后因素多变量分析表明中心启动子突变导致无HBV复发存活期明显缩短。此外，除外不利的肿瘤特征，中心启动子突变是影响肝移植后肝细胞癌复发患者预后的重要因素。在这项研究中，HBV中心启动子突变被发现是影响HBV相关肝细胞癌患者肝移植后临床预后的重要指标。因此，我们建议与此风险因素相关患者可以考虑积极抗病毒治疗。
吉林大学第一医院肝病科 张璐 摘译
本文首次发表于[Ann Surg Oncol,2013 Jun 13]
Liver Transplantation in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma: The Influence of ViralCharacteristics on Clinical Outcome.
Abstract
BACKGROUND:
Hepatitis B virus (HBV) relapse and/or hepatocellular carcinoma (HCC) recurrence remains a major concern for patients who undergoliver transplantation (LT) because of HBV-related HCC. This study investigates the correlation between HBV relapse and HCC recurrence and it explores factors that affect patient outcomes after LT.
METHODS:
Between September 2002 and August 2009, 78 consecutive patients who underwent LT because of HBV-related HCC were enrolled in this study. Serum samples obtained before LT were assayed both for virological factors associated with HBV DNA and for genotypic characteristics of the virus. All patient clinicopathological features and virological factors were assessed further by univariate and multivariate analyses to determine prognostic factors.
RESULTS:
During a median follow-up period of 29.4 months, 13 (16.6 %) patients experienced HCC recurrence and 18 (23.1 %) patients experienced HBV relapse. HBV relapse exhibited a close association with HCC recurrence (p = 0.004) and led to unfavorable overall survival after LT. Multivariate analysis of prognostic factors showed that the basal core promoter (BCP) mutation independently predicted a shorter survival period free from HBV relapse (p = 0.036). Moreover, with the exception of unfavorable tumor characteristics, the BCP mutation was found to be an important prognostic factor that affected HCC recurrence after LT (p = 0.042).
CONCLUSIONS:
In this study, the HBV-BCP mutation was identified as an important predictor of post-LT clinical outcomes in patients with HBV-related HCC. Therefore, we recommend that aggressive antiviral treatment may be considered for patients associated with this risk factor.
