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在接受HAIC-TKI-ICI治疗的HBV相关HCC患者中,HBV再激活及其管理:一项多中心研究

Jiayun Liu^1,2,3, Bo Sun^1,2,3, Jiahua Zou⁴

¹Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

|June 13, 2025

概括

乙型肝炎病毒 (HBV) 再激活发生在14.3%的晚期肝细胞癌 (HCC) 患者中,这些患者接受了四重治疗. 再激活显著恶化了预后,但tenofoviralafenamide fumarate改善了这些患者的存活率.

科学领域:

肝病学肝病学是一种肝病学.
在瘤学瘤学.
病毒学病毒学

背景情况:

肝细胞癌 (HCC) 是一个主要的全球健康问题,特别是在慢性乙型肝炎病毒 (HBV) 感染的患者中.
先进的HCC治疗方法,包括肝动脉输液化疗 (HAIC),氨酸激酶抑制剂 (TKI) 和免疫检查点抑制剂 (ICI),可以增加HBV重新激活的风险.
有效的管理策略对于缓解HBV再激活及其对患者结果的影响至关重要.

研究的目的:

评估在接受HAIC+TKIs+ICIs+entecavir的晚期HBV相关HCC患者中HBV再激活的发生率和危险因素.
评估HBV再激活对无进展生存期 (PFS) 和整体生存期 (OS) 的预后影响.
为了确定tenofovir alafenamide fumarate在控制HBV再激活和改善该患者队列的生存率方面的疗效.

主要方法:

这是一项追溯性研究,涉及来自五个中心的307名患有晚期HBV相关HCC的患者.
患者接受了四重的治疗方案:HAIC+TKI+ICI+entecavir.
进行了统计分析,以确定HBV重新激活的风险因素,并比较重新激活和非重新激活组之间的生存结果.

主要成果:

在44名 (14.3%) 患者中观察到HBV重新激活.
针对HBV再激活的独立风险因素包括HBV-DNA水平≥1×10^4 IU/mL,阳性HBeAg,白细胞计数<4×10^9/L.
与HBV重新激活患者相比,没有HBV重新激活的患者的PFS和OS中位数显著更长 (p<0.001).

结论:

在接受密集治疗的晚期HBV相关HCC患者中,HBV再激活是显著的并发症.
特定的临床和病毒学因素预测HBV复激活风险.
诺福维尔阿拉芬胺胺烟酸在控制HBV再激活和改善受影响患者的生存结果方面表现出有效性.

关键词:

癌症癌症癌症癌症卫生科学卫生科学病毒学病毒学

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