Antiviral Treatment May Reduce Posthepatectomy Tumor Recurrence in HBV-Related HCC

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abdominal surgery
A cohort study evaluated whether antiviral therapy affects the incidence of microvascular invasion after hepatectomy for HBV-related hepatocellular carcinoma.

For patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), undergoing antiviral treatment (AVT) before a partial hepatectomy can decrease the risk for microvascular invasion (MVI) and posthepatectomy early tumor recurrence, according to results published in JAMA Surgery.

The results also indicated that a high preoperative HBV DNA level was an independent risk factor for MVI.

The study included data on a cohort of participants who underwent R0 resection for HBV-related HCC between January 2008 and April 2010 at the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China (n=2362). The median postoperative follow-up period was 44.8 months. The researchers used the Kaplan-Meier method, log-rank test, and Cox regression analysis to calculate and compare overall survival and time to recurrence after surgery. They then used logistic regression analysis to assess independent risk factors of MVI presence.

In total, 86.2% (n=2036) of participants did not receive preoperative AVT, whereas 13.8% (n=326) received ongoing AVT more than 90 days before surgery.

Among participants who did not undergo AVT, preoperative HBV DNA levels ≥2000 IU/mL were associated with an increased risk for MVI compared with HBA DNA levels <2000 IU/mL (odds ratio [OR], 1.399; 95% CI, 1.151-1.701).

Participants receiving AVT had a lower incidence of MVI (38.7% [126 of 326]) compared with participants who did not receive AVT (48.6% [989 of 2036]; P =.001).

Participants receiving AVT also had a reduced risk for MVI (OR, 0.758; 95% CI, 0.575-0.998).

The researchers found that a complete response to AVT was an independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952).

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The results indicated that preoperative AVT was associated with decreased 6-month, 1-year, and 2-year recurrences compared with patients not receiving AVT (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P <.001).

Participants who did not receive AVT were more likely to have multiple intrahepatic recurrences (49.1% [549 of 1119]) compared with participants who received AVT (36.2% [54 of 149]; P =.003).

“Since MVI is also closely associated with tumor recurrence after liver transplantation for HCC, whether pretransplant AVT affects the incidence of MVI in viral-related HCC should be further investigated,” the researchers wrote.


Li Z, Lei Z, Xia Y, et al. Association of preoperative antiviral treatment with incidences of microvascular invasion and early tumor recurrence in hepatitis B virus-related hepatocellular carcinoma [published online August 1, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.2721