Impact of antiviral therapy on the survival outcome of patients after hepatectomy for hepatitis B-related hepatocellular carcinoma

Abstract

BACKGROUND: Although the therapeutic benefit of antiviral treatment in the management of chronic hepatitis B infection (HBV) is well-known, its impact on the survival outcome after hepatectomy for HBV-related hepatocellular carcinoma (HCC) remains unclear. AIM: To evaluate the impact of post-hepatectomy antiviral treatment on the prognosis of HBV-related HCC. METHODS: From September 2003 to December 2007, 42 patients were given Lamivudine (n = 39) or Entecavir (n = 4) after hepatectomy (i.e. treatment group) due to abnormal liver function. Their preoperative data, tumour characteristics and survival outcome were compared with 94 patients who did not receive any antiviral treatment after hepatectomy (i.e. control group). Univariate and multivariate analyses were performed to identify prognostic factors for survival. RESULTS: Patient demographics, preoperative liver function and tumour characteristics were comparable between the two study groups. The liver function reserve at the time of tumour recurrence in the treatment group was also comparable with the control group. There was no significant difference in tumour recurrence rate (47.6% vs. 65%, P = 0.28) and disease-free survival (69.8 vs. 9.2 months, P = 0.05) between the two study groups. Nonetheless, the overall survival was significantly improved in the treatment group (72.3 vs. 33.2 months, P = 0.005). Multivariate analysis identified use of antiviral treatment to be a prognostic factor for prolonged overall survival. Subgroup analysis stratified against tumour stage and portal vein status showed that the survival benefit of antiviral treatment was more pronounced in AJCC stage I/II tumours or HCCs without portal vein invasion. DISCUSSION: Antiviral therapy may improve the prognosis of HBV-related HCC by inhibition of hepatitis activity in the liver remnant. CONCLUSION: Antiviral treatment should be considered after hepatectomy for HBV-related HCC especially in early stage tumours.