Anti-HBV Therapy Aids Survival After Hepatectomy

June 22, 2011

NEW YORK (Reuters Health) Jun 21 - Antiviral therapy after hepatectomy improves survival in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma, according to a report in the June Archives of Surgery.

Patients with hepatocellular carcinoma (HCC) frequently have HBV infection, Dr. Albert C. Y. Chan of The University of Hong Kong and Queen Mary Hospital and his colleagues note.

About half of patients who undergo hepatectomy for HCC will have a recurrent cancer within five years. Further resection can be difficult, they add, due to impaired function of the remnant liver.

To investigate whether antiviral therapy might extend survival in these patients, the researchers performed a retrospective analysis of 136 patients who had major hepatectomy for HBV-related HCC. All were antiviral naive before the surgery.

Forty-two received antiviral treatment after surgery. At first, study patients received lamivudine; later the researchers used entecavir because of its more powerful effects against HBV. Treatment started a median of eight days after surgery.

With antiviral treatment, overall one-, three-, and five-year survival rates were 88.1%, 79.1%, and 71.2%, respectively. Without it, survival was 76.5%, 47.5%, and 43.5%, respectively (P=.005).

Disease-free survival in the treatment group was 66.5% at one year, 51.4% at three years, and 51.4% at five years; for the control group, it was 48.9%, 33.8%, and 33.8%, respectively (P=.05).

Multivariate analysis showed that antiviral therapy independently predicted long-term survival (relative risk, 0.35), as did tumor size of 5 cm or less (RR 1.11), no major vascular invasion (RR 2.16), and AJCC stage I and II disease (RR 1.51).

However, antiviral treatment did not improve survival in patients with stage III tumors or major vascular invasion.

Tumor recurrence rates were similar in the two groups, the researchers note, which showed that antiviral treatment didn't directly affect tumor growth.

"Together, these findings correlate nicely with the potential mechanisms of intrahepatic 'recurrence' and hepatitis-related mortality after a potentially curative resection," Dr. Christopher Wolfgang of The Johns Hopkins University in Baltimore writes in an editorial accompanying the study.

It would be "intriguing," he adds, to compare patients who undergo resection plus antiviral therapy for HBV-related HCC to stage-matched patients who receive transplants. He wonders: "Is it possible that antiviral therapy following resection of early stage HCC can attenuate the 'field defect' that is eliminated in liver transplant?"


Arch Surg 2011.


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