Antiviral Therapy Improves Postoperative Survival In Hepatocellular Carcinoma

Antiviral therapy reduces late hepatocellular carcinoma recurrence to improve long-term survival after R0 hepatic resection

medwireNews: Antiviral therapy reduces late hepatocellular carcinoma (HCC) recurrence and improves overall survival in patients undergoing R0 hepatic resection for hepatitis B virus (HBV)-related cancer, a randomised controlled study shows.

“It is our belief that antiviral treatment exerts no direct antitumor effect, but its main therapeutic effects are to inhibit hepatitis activity and to reduce chronic inflammation in the liver remnant, thus decreases the chance of developing a second primary HCC”, the researchers comment in the Annals of Surgery.

They randomly assigned 200 patients who underwent R0 hepatic resection for HBV-related HCC to receive no treatment or antiviral therapy (adefovir 10 mg/day).

“As aggressive tumor characteristics might overshadow the effect of antiviral treatment and lead to early tumor recurrence, we studied only patients with a solitary tumor, with clear microscopic resection after margin after hepatectomy, and with no extrahepatic metastasis”, the team writes.

Over a median follow-up of 60 months, HCC recurred in 124 (62.0%) patients and 97 (48.5%) patients died. Also, 16 patients in the control group were given antiviral therapy due to HBV reactivation.

The recurrence-free survival rates for patients in the antiviral group were 85.0% at 1 year, 50.3% at 3 years and 46.1% at 5 years. This compared with respective rates of 84.0%, 37.9% and 27.1% for the control group.

Overall survival rates for the antiviral and control groups were 96.0% versus 94.0% at 1 year, 77.6% versus 67.4% at 3 years, and 63.1% versus 41.5% at 5 years.

For both variables the difference at the 5-year follow-up was significant in favour of antiviral therapy. And such therapy was found to be an independent protective factor against both tumour recurrence and death on multivariate analysis, being associated with risk reductions of 35% and 58%, respectively.

The researchers add, however, that when they looked at patients with early (within 2 years of liver resection; n=83) and late (>2 years; n=41) recurrence separately, antiviral therapy was only associated with a significantly lower risk of late recurrence, at 65%.

Factors contributing to an increased risk of recurrence and death included a tumour size bigger than 5 cm, tumour encapsulation, and the presence of microsatellite nodules and microportal vein tumour thrombus.

Researcher Wei-ping Zhou, from Eastern Hepatobiliary Surgery Hospital in Shanghai, China, and co-workers note that their study only included patients with serum an HBV-DNA load of more than 2000 IU/mL in accordance with recommendations at the time, and conclude: “All these patients should receive early and effective antiviral treatment without delay.”


Huang G, Lau WY, Wang ZG, Pan ZY, et al. Antiviral Therapy Improves Postoperative Survival in Patients With Hepatocellular Carcinoma: A Randomized Controlled Trial. Ann Surg 2014; Advance online 28 July. [Epub ahead of print]

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