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

Abstract

BACKGROUND: Although the therapeutic benefit of anti-viral treatment in the management of chronic hepatitis B infection (HBV) is well established, it remains uncertain if commencement of anti-viral therapy after hepatectomy in anti-viral naïve patients with hepatocellular carcinoma (HCC) would improve their survival outcome. METHODS: From September 2003 to December 2007, 42 patients (i.e. treatment group) were given Lamivudine (n = 39) or Entecavir(n = 4) after hepatectomy for HBV-related HCC. All these patients were anti-viral naïve before hepatectomy. Their preoperative data, tumor characteristics and survival outcome were compared with 94 patients without any antiviral treatment after hepatectomy (i.e. control group). RESULTS: The median age for treatment and control group were 57 and 55 years old respectively (P = 0.77). Patient demographics, preoperative liver function, tumor characteristics, liver function at the time of tumor recurrence were comparable between the two groups. Both disease-free and overall survival rates were significantly improved in the treatment group. The 1-, 3-, and 5-year overall survival rate in the treatment group was 88.1, 79.1, and 71.2% respectively, and in the control group was 76.5, 47.5, and 43.5% respectively (P = 0.005). The 1-, 3- and 5-year disease-free survival rate in the treatment group was 66.5, 51.4, and 51.4% respectively, and in the control group was 48.9, 33.8, and 33.8% respectively (P = 0.05). Subgroup analysis stratified against tumour stage and portal vein status showed that post-hepatectomy antiviral treatment confers a significant survival benefit in AJCC stage I/II tumours or HCCs without portal vein invasion. CONCLUSION: Anti-viral naïve HBV carriers could still benefit from the therapeutic effect of anti-viral treatment after curative treatment for hepatocellular carcinoma.