原发性肝癌术后HBV活跃复制者拉米呋啶治疗对肿瘤复发的影响

目的 探讨肝癌根治术后HBVDNA活跃复制病人应用拉米呋啶治疗对肿瘤复发的影响.方法 将41例原发性肝癌根治性切除术后血清HBVDNA＞105 copies/ml病人随机分2组:治疗组21例(手术切除+拉米呋啶),对照组20例(单纯手术切除);同期22例肝癌根治术后HBVDNA ＜500 opies/ml病人作阴性组.观察各组术后血清HBVDNA、ALT水平、e抗原表达、复发时间作统计学分析.结果 治疗组和对照组术后1年HBVDNA清除率为76.2%和15%(P＜0.01),e抗原转阴率为45.5%和22.2%(P＞0.05);治疗组、对照组、阴性组术后1年肝癌复发率分别为28.98%、50%、22.73%,治疗组显著低于对照组(P=0.022),与阴性组无差异(P=0.508);治疗组与对照组术后中位复发时间分别为20个月和11个月(P=0.043).结论 肝癌根治术后HBV活跃复制者应用拉米呋啶治疗可提高HBVDNA清除率,有助于延长肿瘤复发时间.

Effect of postoperative anti-viral therapy using lamivudine on recurrence of hepatocellular carcinoma in patients with active HBV replication

Objective To investigate the effect of postoperative anti-viral therapy using lamivudine on recurrence of hepatocellular carcinoma (HCC) in patients with active HBV replication.Methods Forty-one HCC patients with high serum HBVDNA level (＞ 105 copies/ml) undergoing radical hepatectomy were randomized into two groups. The patients in group Ⅰ (n=20) received hepatectomy alone while those in group Ⅱ (n=21) received postoperative lamivudine therapy. Another 22 HBVDNA-negative (＜500 copies/ml) HCC patients receiving hepatectomy in the same period of time were employed to serve as negative contract group ( Ⅲ ). The serum levels of HBVDNA and ALT, HBeAg seroconversion rate, tumor recurrence rate were observed and compared by SPSS software. Results In Group Ⅰ and Group Ⅱ , the 1-year HBVDNA suppression rate was 76.2% vs 15%(P＜0.01) and HBeAg seroconversion rate 45.5% vs. 22.2% (P＞0.05). The median recurrence time was 20 vs. 11 months (P＜0. 001). The tumor recurrence rate in Group Ⅰ , Ⅲ and Ⅲ was 50%, 28.98% and 22.73% ,respectively. There was significant difference between Group Ⅰ and Ⅱ but no marked difference between Group Ⅱ and Ⅲ. Conclusions Lamivudine therapy may play an important role in suppressing the HBV and delaying the recurrence of HCC in patients with active HBV replication.