Clinical Outcomes Of Nucleos(t)ide Analogue Resistance And Pre-existing Drug Resistance In The Hepatitis B Virus-related Hepatocellular Carcinoma Patients After Radical Resection

Objective:To evaluate on the decision-making of antiviral treatment for postoperative patients with HBV-related hepatocellular carcinoma(HCC)after developing resistance to NAs based on analyzing the clinical manifestations,lifespan and other prognostic factors,comparing with those who were NAs sensitive or no NAs treatment.The pre-existed resistance profiles was ustilized for the judgement of the NAs resistance.Methods:Data about 482 HBV-related HCC patients who were hospitalized repeatedly in our hospital from January 2011 to July 2014 after post-hepatectomy of HBV-related HCC were reviewed and followed-up;and none of the patients received NAs antiviral treatment before surgery.The patients' medical history,serological test results,imaging examination findings,pathological examination results and serum were collected.HBV genotype detection and detection of drug-resistant mutation sites before and after medication usage were performed on the same patient.The pre-existing drug resistance spectra were analyzed on these patients as well.According to the detection status of drug-resistant mutation site after NAs administration the patients were divided into NAs-resistant group,NAs sensitive group,and NA-free group.The statistical software SPSS 21.0 was employed to compare differences among groups using Chi-square test results,T test results or rank sum test results and Kaplan-Meier survival curve.Results:Notably,the NAs-resistant postsurgery patients showed significantly worse aminotransferase values,HBV-DNA levels,HBs Ag titer,Child-Pugh score,disease-free survival rate(DFS)and overall survival rate(OS)not only comparing to NAs-sensitive patients(P<0.05),but also to NAs-free(P<0.05).Of the 204 cases of patients who did not take NAs before operation,39 cases were found to have pre-existing drug resistance,33 of whom were affected in terms of prognosis due to inappropriate selection of drugs.Conclusion:Considering the poorer survival rate for NAs-resistant postsurgery patients,it is necessary to choose high-efficacy but low resistance barrier antiviral drugs for patients with HBV-related HCC.And it may be helpful conducting pre-existing drug resistance detection before usageof NAs.