| Purpose and significance:This study aimed to compare the difference between the survival rates of hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)patients with lamivudine,telbivudine,and entecavir treatment,and to provide evidence for selecting nucleoside analogues for patients with HBV-related HCC.Method:This study retrospective recruited HCC patients from the First Affiliated Hospital of Xi'an Jiaotong University from January 2007 to January 2012.The data were collected and the clinical data database was established using Microsoft Excel 2003.All data were then analyzed using SPSS19.0.Package.Results:1.Overall survival of HBV-related HCC patients1.1 Clinical features of patients with HBV-related HCC Of the 450 patients,206 patients used lamivudine,114 patients used telbivudine and 130 patients used entecavir.1.2 Cumulative survival in patients with HBV-related HCC The 206 patients with lamivudine treatment had a median survival of 24 months the 1-,3-,and 5-year survival rates of HBV-related HCC patients were 76.2%,34.5%,and 16.0%,respectively;The 114 patients with telbivudine treatment had a median survival of 34 months,and the 1-year,3-year,and 5-year survival rates were 84.2%,43.1%,and 27.2%,respectively;The 130 patients with entecavir treatment had a median survival of 37 months,and the 1-year,3-year,and 5-year survival rates were 85.4%,52.6%,and 25.4%,respectively.There was a statistically significant difference in the survival rates among the three groups of antiviral drugs(P=0.001),between entecavir and lamivudine(P=0.002)and between telbivudine and lamivudine(P=0.001)treatments.There was no significant difference in survival rates between entecavir and telbivudine treatments(P=0.885).1.3 Prognosis related factors in patients with HBV-related HCC Multivariate COX regression analysis revealed that BCLC staging,portal vein tumor thrombus formation,different antiviral drugs and different treatment methods are independent risk factors for prognosis of HBV-related HCC patients.2.Subgroups survival of HBV-related HCC patients2.1 Survival of curative treatment HBV-related HCC patients 2.1.1 Clinical characteristics of curative treatment HBV-related HCC patients Of the 173 patients,98(56.6%)had surgical resection and 75(43.4%)had radiofrequency ablation.2.1.2 Analysis of cumulative survival time in patients with curative treatment The lamivudine treated 74 patients had a median survival of 31 months and the 1-,3-,and5-year survival rates were 83.8%,39.2%,and 24.3%,respectively;The 41 patients received telbivudine had a median survival of 43 months and the 1-year,3-year,and 5-year survival rates were 90.2%,55.2%,and 52.1%,respectively;The 58 patients in the entecavir group had a median survival of 48 months and the 1-year,3-year,and 5-year survival rate was 93.1%,65.9%,and 37.9%,respectively.There was a statistically significant difference in survival rates among the patients with the three antiviral drugs(P=0.003),between entecavir and lamivudine(P=0.006)and between telbivudine and lamivudine(P=0.005).There was no significant difference in survival between entecavir and telbivudine treated patients(P=0.840).2.1.3 Prognostic factors in patients with curative treatment Multivariate COX regression analysis found that AFP,Child-Pugh grading,BCLC staging,and different antiviral drugs were independent risk factors for the prognosis of HBV-related HCC patients.2.2 Survival analysis of TACE treatment group in patients with HBV-related HCC2.2.1 Clinical characteristics of TACE treatment patients Of the 108 patients,54 were treated with lamivudine,25 with telbivudine and 29 with entecavir.2.2.2 Cumulative survival time in TACE treated patients In 54 patients with lamivudine,the median survival period was 29 months,and the 1-,3-,and 5-year survival rates were 85.2%,37.0%,and 12.9%,respectively;The 25 patients with telbivudine had a median survival of 27 months and the 1-,3-,and 5-year survival rates were76.0%,44.0%,and 20.0%,respectively;The 29 patients in the entecavir group had a median survival of 31 months,and the 1-,3-,and 5-year survival rates were 86.2%,34.5%,and 13.8%,respectively.There was no statistical difference between the three drugs(P=0.877).2.2.3 Prognostic factors in TACE treated patients Multivariate COX regression analysis found that Child-Pugh grading,BCLC staging and portal vein tumor emboli formation are independent risk factors for prognosis of HBV-related HCC patients.2.3 Survival analysis of patients with supportive treatment 2.3.1 Characteristics of patients with supportive treatment Of the 155 patients received supportive treatment,70 patients used lamivudine,44 patients used telbivudine,and 41 patients used entecavir.2.3.2 Cumulative survival time in the HBV-related HCC patients with supportive treatment In the lamivudine group,the 70 patients had a median survival of 18 months.The 1-year,3-year,and 5-year survival rates were 62.9%,25.7%%,and 7.1%,respectively;The 44 patients received telbivudine had a median survival of 24 months and the 1-year,3-year,and 5-year survival rates were 60.3%,34.1%,and 2.3%,respectively;The 41 patients in the entecavir group had a median survival of 30 months,and the 1-year,3-year,and 5-year survival rates were 61.0%,12.2%,and 9.8%,respectively.There was no statistical difference between these three drugs(P=0.602).2.3.3 Prognostic factors in the HBV-related HCC patients with supportive treatment Multivariate COX regression analysis found that TNM staging is an independent risk factor for prognosis of HBV-related HCC patients.Conclusion:The survival time of HBV-related HCC patients treated with entecavir and telbivudine was significantly longer than that of lamivudine-treated patients.In subgroup analysis,in the patients receiving curative treatment,the survival time of patients treated with entecavir and telbivudine was significantly longer than that of patients treated with lamivudine,and there was no significant difference in the survival time between patients treated with entecavir and telbivudine.In patients who received TACE and supportive therapy,there was no difference in the survival time of the three nucleoside antiviral drugs. |
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