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Reuters Health Information: Preop antivirals may curb early recurrence of HBV-related HCC

Preop antivirals may curb early recurrence of HBV-related HCC

Last Updated: 2018-08-08

By Marilynn Larkin

NEW YORK (Reuters Health) - In patients undergoing partial hepatectomy for hepatitis-B virus (HBV)-related hepatocellular carcinoma (HCC), antiviral therapy (AVT) given more than 90 days before surgery is associated with fewer incidences of microvascular invasion and early tumor recurrence, researchers say.

Dr. Feng Shen of Second Military Medical University in Shanghai and colleagues studied 2,362 patients (median age 50.6; 85% men) who underwent R0 resection (for cure or complete remission) for HBV-related HCC between January 2008 and April 2010 at a single Shanghai hospital. Median postoperative followup was 44.8 months.

Whereas 86.2% of patients did not receive any preoperative AVT, 13.8% had continuously received at least one type of antiviral medication for more than 90 days before surgery.

As reported online August 1 in JAMA Surgery, in the non-AVT group, preoperative HBV DNA levels of 2,000 IU/mL or more were associated with an increased risk of microvascular invasion (odds ratio, 1.399) compared with preoperative levels of less than 2,000 IU/mL.

Those who received AVT had a lower incidence (38.7% vs.48.6%) and reduced risk (OR, 0.758) of microvascular invasion compared with the non-AVT group.

A complete response to AVT was an independent protective factor against microvascular invasion (OR, 0.690). Thus, preoperative AVT was associated with decreased six-month (14.2% vs. 23.4%), one-year (24.6% vs. 37.1%), and two-year recurrences (38.5% vs. 52.3%) compared with no AVT.

AVT also protected against early tumor recurrence (hazard ratio, 0.732).

Further, those in the non-AVT group were more likely to have multiple intrahepatic recurrences (49.1% vs. 36.2%) and recurrences involving multiple hepatic segments compared with those who had AVT.

"Viral infection coexists and is responsible for more than a million cases of liver cancer worldwide," Dr. Yuman Fong of City of Hope Medical Center in Duarte, California, author of an accompanying editorial, told Reuters Health. "Both tumor and infection can be treated effectively, and potentially cured."

"Combined use of surgery and antiviral therapies is potentially curative for the individual, and may prevent future infections and cancers in the community," Dr. Fong, who is also Editor-in-Chief of Molecular Therapy Oncolytics, said by email.

However, he added, "Some evidence exists that treating hep C may be associated with early recurrence of cancer. Therefore, I would recommend early (at three months) surveillance."

In his editorial, Dr. Fong also advised that family members of the patient be evaluated for the presence of viral infection. "Treating unrecognized viral infection is an effective way of preventing HCC," he concluded.

Dr. Thomas Schiano, Medical Director of Adult Liver Transplantation and Director of Clinical Hepatology and Intestinal Transplantation at the Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York City, told Reuters Health, "This study helps confirm the many benefits of adequate hepatitis B virus (HBV) treatment; decreasing risk for liver cancer is one of them as well as preventing the development of cirrhosis."

"With the wonderful, highly effective and well-tolerated medications in our armamentarium, there is no downside to treating all patients having HBV," he said by email.

"The results of this study give further credence to this approach," he said. "All patients undergoing therapy, whether it is liver resection or radiological therapy of primary liver cancer, should be aggressively treated with HBV medications in order to help prevent recurrent HCC - but even more importantly, to prevent new cancers from developing and to stabilize and even improve any underlying liver dysfunction in order to help mitigate the future need for liver transplantation."

"If HCC recurs after HBV viremia has been adequately treated," he added, "patients may be able to better tolerate future and ongoing treatment of their HCC."

Dr. Shen did not respond to requests for a comment.


JAMA Surg 2018.

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