Evaluation Of Clinical Efficacy Of Different Nucleoside Analogues Combined With TACE In Treatment Of HBV Associated Hepatocellular Carcinoma

Object: To evaluate the clinical efficacy of different nucleotide analogues combined with TACE(transarterial chemoe-mbolization)in the treatment of hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC).To explore the difference of therapeutic effects of different therapeutic schemes,and to provide the clinical basis for the selection of more effective treatment.Methods: Historical cases were analysised with case-control method.Totally 132 hepatocellular carcinoma patients with HBsAg(+)and HBV-DNA(+)were enrolled in the Department of Gastroenterology,Department of hepatobiliary surgery and Department of Interventional of the First Affiliated Hospital of Southwest Medical University from January 2014 to March 2015.All patients were excluded from other types of hepatitis and were not treated with antiviral therapy(interferon and nucleoside analogues)before.The patients were randomly divided into three groups according to the combination of antiviral therapy.Entecavir combined with TACE group(group A)with a total of 45 cases;Lamivudine combined with TACE group(group B)with a total of 47 cases and Only TACE group(group C)with a total of 40 cases.All patients were treated with TACE,after the first time of TACE treatment,the A and B groups were treated with oral antiviral drugs regularly for a long time.The C group was treated with TACE alone.Follow up was every 4-6 weeks,to compare the similarities and differences of the baseline levels,the liver function(with ALT as the main index),AFP,HBV-DNA level of 4th week,12 th week,24 th week and 48 th week;and to evaluate the reactivation rates of hepatitis B virus,the negative conversion rates of HBV-DNA,the negative and serum conversion rates of HBeAg among the three groups after the treatment.The deadline date of follow-up was 30 th December 2016.The clinical effective rates and disease control rates were observed and compared between the three groups,and the survival rates,the Overall Survival time and the time of Progression-Free-Survival were analyzed.Results:1.TACE treatment can lead to reactivation of hepatitis B virus,the rates of HBV reactivation of the A,B,C groups of patients were 6.67%,19.15%,42.50% at 48 th week;the negative rates of HBV were 64.44%,36.17%,7.5%,the differences among the three groups were statistically significant(A group>B group>C group,P<0.05).The negative and serum conversion rates of HBeAg of A group were 58.33%,20.83% at 48 th week,and the rates of B group were 37.03%,14.81%,it did not appear negative and seroconversion of HBeAg in the C group;the negative rate of HBeAg in group A was higher than that in group B,the difference was statistically significant(P<0.05).The serum conversion rates of HBeAg between the two groups were no significant difference(P >0.05).2.The levels of HBV-DNA,ALT and AFP in two groups of A and B decreased gradually with the prolong of treatment time,The levels of HBV-DNA and ALT after 4 weeks of the treatment and the levels of AFP after 12 weeks of the treatment were statistically significant(P<0.05).The ability to reduce the levels of HBV-DNA,ALT and AFP in the group A was better than that in the group B.Especially in the 4th and 12 th week after antiviral treatment,the difference between the two groups was statistically significant(P < 0.05).The levels of HBV-DNA and ALT in the C group were maintained at a high level,while AFP showed a downward trend,and the difference was statistically significant at 48 th weeks.3.The Child-Pugh score of the three groups changed at the treat-ment time of 24 th week and 48 th week in the A group,the scores of A group were significantly improved compared with B and C groups(P<0.05).After the treatment for 48 th week,the score of B group was statistically significant difference compared with C group(P<0.05).4.The median survival times with the three groups of patient were 26,22 and 19 months,the median progression free times were 17,13 and 9 months;The clinical effective rate(RR)of entecavir group(A group)was 48.90%,the disease control rate(DCR)was 82.20%;The rates of RR and DCR of lamivudine group(B group)were 44.70% and 80.90%,and the rates were only 37.50% and 72.50% in the Only TACE group(C group).There were no statistical significance in short-term effects among the three groups(P>0.05).In A group,the median survival time and median progression free time were better than that in the B and C group,the difference was statistically significant(P<0.05).5.Univariate and multivariate analysis showed that: group,AFP,embolization,portal vein tumor thrombus,HBV high viral load,HBe Ag(+),TACE times of treatment were independent prognostic factors in patients with HBV-related hepatocellular carcinoma(P < 0.05),The times of TACE treatment was a protective factor related to prognosis.Conclusion:1.Nucleotide analogues combined with TACE treatment can control the reactivation of hepatitis B virus and inhibit HBV replication and promote the transformation of HBV serum markers at the same time.2.Nucleotide analogues can effectively stabilize and improve liver function,decrease tumor recurrence and metastasisl,and extend the survival time of patients with HBV-related HCC.3.The clinical efficacy of nucleotide analogues combined with TACE in the treatment of HBV-related HCC was more effective than that of TACE alone,The efficacy of entecavir was superior to lamivudine.