| BackgroundPrimary hepatocellular carcinoma is the most common malignant tumors, about90%of patients with hepatitis B virus (hepatitis B virus, HBV) infection[1]. HBV(hepatitis B virus, HBV) is one of the primary cause of liver cancer (primaryhepatocellular carcinoma, PHC) The high HBV viral load is an important factor in thedevelopment and prognosis of liver cancer, surgery, partial thrombosis, radiation therapycan make the hepatitis B virus replication, and has a impact of cancer treatment. Similarto hepatitis patients, antiviral treatment of hepatitis B virus is the same basic method oftreatment-related liver cancer, surgery, interventional therapy and combined withanti-viral therapy can effectively control tumor recurrence and metastasis rate and reducethe viral load and prolong survival time and improve survival quality.Antiviral therapyfor HBV-related liver cancer therapy is the current hotspot.There is too much side effects interferon and resistance rate of lamivudine andadefovir, limiting their long-term use. In2005l entecavir was approved and its fast andpotent antiviral activity, low resistance, was soon be favored.Because entecavir came late,its exact clinical efficacy has not yet been reached. Therefore, this article entecavirantiviral efficacy of a number of clinical indicators were analyzed in order to observe theexact entecavir antiviral effect, in order to provide reference for clinical use. AimesTo study the therapeutic efficacy of Entecavir with TACE for patients with hepatitisB virus related unresectable hepatocellular carcinoma and The4,12,2448W follow-up ofliver function, HBV DNA level, HBeAg seroconversion rate and conversion rate weredetermined in a11the patients and compared between the2groups, To investigate the affprognostic factors and effects antiviral therapy on HBV-related primary hepatocellularcarcinoma, and evaluate the role of antiretroviral therapy objectively.Methods:145patients were devided into the treamtment group and the control group, theywere treated by TACE.The treamtment group were treamted by Entecavir. The controlgroup were treamted by general remedy. Methods：From May2008to September20l0，a total of145patients with intermediate-advanced HCC and preserved liver functionwere randomly assigned to be treated with control group (underwent TACE alone) ortreatment group (TACE+Entecavir). The4,12,24,48W follow-up of liver function,HBV DNA level, HBeAg seroconversion rate and conversion rate were determined ina11the patients and compared between the2groups.To assess the treatment effect basedon mRECIST，the time for progression-free survival (PFS)，overall survival (OS) timeand adverse events were recorded．Results1. The ALT levels of the two groups patients improved significantly during thefollow-up,and the24w ALT levels were significantly lower observed in the treatmentgroup than in the control group (P<0.05).2. The4,12,24,48w of HBV DNA undetectable rate after treatment were27.3%,36.4%,45.5%and72.7%respectively in the treatment group,while the HBV DNA levelshas no significant change in the control group. After48weeks the HBeAgseroconversion rate in the observation group was42.9%, and the HBeAg conversion ratewas14.3%; while the patients had no HBeAg seroconversion or conversion in the control group.3. Univariate analysis showed that AFP, ALB, TBIL, ALT, AST, GGT, PT, ascites,tumor number, location of the tumor, portal vein tumor thrombosis, extrahepaticmetastasis, clinical stage, pain, groupt, Child-Pugh classification, ECOG score andantiviral therapy in the prognosis of HBV-related primary hepatocellular carcinomawere statistically significant (P<0.05). while the gender, age, HBV DNA positive andliver cirrhosis was not statistically significant (P>0.05).4. Multivariate analysis showed that AST, GGT, Child-Pugh grade, clinical stage,portal thrombosis, group and antiviral therapy in the prognosis of HBV-related primaryhepatocellular carcinoma were statistically significant (P<0.05), while the AFP, ALT,tumor number, location, extrahepatic metastasis, pain, treatment, ECOG score was notstatistically significant (P>0.05).5. Till November20ll,41patients (53.95%) survived and35patients (includepatients lost to visit) died (46.05%) among the treatment group,19patients survived(27.53%) and50patients (include patients lost to visit) died (72.46%) among the controlgroup. The disease control rate (DCR) and ORR (objectiv e response Rate) havestatistical significance in the two groups (P＜0.05)．The median overall survival time(mOS) of treatment group and control group were18.5(95％CI:15.5～21.5) months and12.3(95％CI:9.8～14.9) months respectively，and the difference reached statisticalsignificance (Χ2=6.857, P=0.009)．The median progression-free survival (mPFS) oftreatment group and control group were8.4(95％CI:6.9～9.9) months and5.9(95％CI:4.9～6.8) months respectively，and the difference reached statistical significance (Χ2=8.570, P=0.003).Conclusions1. Entecavir can strongly, quickly restrain HBV, and prolong the time of thetreatment with more significant effects.2. Entecavir still can obviously improve liver function, and the inflammationgrading of liver.3. AST, GGT, Child-Pugh classification, clinical stage, portal vein thrombosis, group and antiviral therapy are the independent prognostic factors of HBV-relatedprimary liver cancer, while AST, GGT, Child-Pugh classification, clinical stage, portalvein tumor thrombus are risk factors, groups and anti-viral treatment was a protectivefactor.4. The patiens underwent Entecavir combined with transcatheter arterialchemoembolization (TACE) treatment compared with TACE alone treatment，entecavirantiviral therapy can quickly suppress HBV replication, reduce liver inflammation inpatients with stable liver function, improve patient quality of life and improve prognosisafter TACE treatment of HBV-related PHC. |
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