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자료유형
학술저널
저자정보
저널정보
대한간학회 Clinical and Molecular Hepatology Clinical and Molecular Hepatology 제22권 제4호
발행연도
2016.1
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458 - 465 (8page)

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Background/Aims: Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. Methods: This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. Results: Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P=0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P=0.013), hypoalbuminemia (HR=3.990, P=0.015), and absence of antiviral therapy (HR=7.597, P=0.006) were significantly associated with treatment-related hepatic decompensation. Conclusions: Our findings suggest that preemptive antiviral therapy significantly reduces the risk of acute hepatic deterioration. Preventing hepatic deterioration during TACE by applying such a preemptive approach may facilitate the continuation of anticancer therapy and thus improve long-term outcomes. (Clin Mol Hepatol 2016;22:458-465)
#Acute hepatic decompensation #Chronic hepatitis B #Hepatocellular carcinoma #Transarterial chemoembolization #Preemptive antiviral treatment

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참고문헌 (24)

참고문헌 신청
El-Serag HB / 2011 / Hepatocellular carcinoma / N Engl J Med 365:1118~1127 google schola Ikai I / 2005 / Report of the 16th follow-up survey of primary liver cancer / Hepatol Res 32:163~172 google schola Bruix J / 2011 / Management of hepatocellular carcinoma: an update / Hepatology 53:1020~1022 google schola Lo CM / 2002 / Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma / Hepatology 35:1164~1171 google schola Llovet JM / 2002 / Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial / Lancet 359:1734~1739 google schola

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