| Objective:By comparing the efficacy and survial of antiviral treatment and not given antiviral treatment on patients with hepatitis B virus(HBV)related hepatocellular carcinoma(HCC),to investigate the effects of antiviral treatmen on the prognosis of HBV related HCC,and analyze the prognostic factors of HBV related HCC,providing the basis for the improvement and the three level prevention of HCC.Methods:Through cohort study method,selecting 626 cases of HBV related HCC patients in Fourth Hospital of Hebei Medical University from January 1,2013 to December 31,2015.All the subjects were positive for Hepatitis B surface antigen(HBs Ag)and were diagnosed as hepatocellular carcinoma according to the diagnostic criteria of hepatocellular carcinoma(2011 Edition).According to whether the patients given antiviral therapy were divided into antiviral therapy group and non-antiviral therapy group,the overall survival and 1-year,2-year and 3-year survival rates were compared between the two groups.Comparing the survival rates of patients with different Barcelona Clinic Liver Cancer Classification(BCLC)staging and different treatments on the basis of antiviral therapy,the treatments including surgical reresection,transcatheter arterial chemoembolization(TACE),surgical reresection+TACE and conservative treatment.All patients were followed up and the deadline of following up was January,2017.All datas were analyzed by SPSS21.0,Survival analysis were performed by Kaplan-Meier method,The survival rates of the two groups were compared by Log-rank test,Multivariate analysis were used by COX proportional hazards model.P<0.05 was statistically significan.Results:1 Comparison of the clinical data about antiviral therapy and non-antiviral therapy In 626 patients with HBV related HCC,there were 292 patients with antiviral therapy,and 334 patients without antiviral therapy.In antiviral therapy group,there were 249 males and 43 females,the mean age was(56.6±9.5)years;66 patients had portal vein tumor thrombus,15 patients had peritoneal metastasis,205 patients had solitary tumor,87 patients had multiple tumors,47 patients had tumor diameter were less than 3cm,74 patients had tumor diameter were 3~5cm,92 patients had tumor diameter were more than5 cm,124 patients had serum AFP equal or more than 400?g/L,168 patients had serum AFP less than 400?g/L,106 patients had HBV-DNA equal or more than10^3copy/ml;in the Child-Pugh classification,243,48 and 10 patients were graded as A,B and C;in Barcelona Clinic Liver Cancer Classification staging,5,91,104,82 and 10 patients were staged as 0,A,B,C and D.In non-antiviral therapy group,there were 283 males and 53 females,the mean age was(56.1 ± 9.3)years;86 patients had portal vein tumor thrombus,31 patients had peritoneal metastasis,231 patients had solitary tumor,103 patients had multiple tumors,11 patients had tumor diameter were less than 3cm,64 patients had tumor diameter were 3~5cm,138 patients had tumor diameter were more than 5cm,166 patients with serum AFP equal or more than400?g/L,169 patients with serum AFP less than 400?g/L,49 patients had HBV-DNA equal or more than 10^3copy/ml;in the Child-Pugh classification,236,80 and 18 patients were graded as A,B and C;in Barcelona Clinic Liver Cancer Classification staging,2,48,143,123 and 18 patients were staged as 0,A,B,C and D.2 Comparison of survival time between antiviral therapy group and non-antiviral therapy groupThe mean survival time was(39.1±2.1)months and the median survival time was 36 months and the 1-year,2-years,3-years survival rates were64.3%,53.9%,49.3% of antiviral therapy group.The mean survival time was(20.1 ± 1.4)months and the median survival time was 9 months and the1-year,2-years,3-years survival rates were 43.1%,29.0%,23.1% of non-antiviral therapy group.Log-rank test showed that the difference between the two groups were statistically significant(X2=46.8 P<0.001).3 The effect of BCLC staging combined with antiviral treatment on survivalThere were significant difference on the 1-year,2-years,3-years survival rates between those group that antiviral treatment and group without antiviral treatment in the BCLC staging B and C(X2=5.4 P=0.02;X2=21.7 P<0.001).4 Comparison of the the survival time between antiviral therapy and non-antiviral therapy of different treatmentsThere were significant difference on the 1-year,2-years,3-years survival rates between those group that antiviral treatment combine with surgery resection,TACE,resection+TACE,conservative treatment and groups without antiviral treatment(X2=7.9 P=0.005;X2=9.9 P=0.002;X2=8.3 P=0.004;X2=21.0 P<0.001).5 Comparison of survival curves between surgical resection and surgical resection+TACE on the based of antiviral therapyOn the basis of antiviral treatment,there was no significant difference in the overall survival of patients who received TACE after surgical resection and radical resection(X2=0.006 P=0.936).6 Univariate analysis of affect the prognostic of HBV related HCCUnivariate analysis showed that AFP,intrahepatic metastasis,hepatic encephalopathy,portal vein tumor thrombus,ascites,peritoneal metastasis,distant metastasis,tumor number,tumor size,HBV-DNA,Child-Pugh classification,BCLC staging,therapeutic method and antiviral treatment were related with prognosis(P<0.05).However,gender,age and cirrhosis of the liver,werenot related with prognosis(P>0.05).7 Multivariate analysis of affect the prognostic of HBV related HCCMultivariate analysis showed that AFP,ascites,tumor number,tumor size,BCLC staging,antiviral treatment were independent factors.AFP,ascites,tumor number,tumor size and BCLC staging were risk factors,antiviraltreatment was protective factor.Conclusion:1 Antiviral treatment can extend the survival of patients with hepatitis B related hepatocellular carcinoma.2 On the basis of antiviral treatment,the earlier the BCLC staging,the longer the survival time3 On the basis of antiviral treatment,prophylactic TACE treatment after radical resection can improve the survival rate of patients,but it is equivalent to simple surgical treatment.4 AFP,ascites,tumor number,tumor size,BCLC staging,antiviral treatment were independent factors affecting the prognosis of those patients. |
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