Preoperative antivirals lower recurrence risk in HBV-related liver cancer
medwireNews: Patients who receive antiviral therapy (AVT) for more than 90 days prior to hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) have a reduced risk for microvascular invasion (MVI) and early tumor recurrence, Chinese research shows.
Compared with patients who did not receive preoperative AVT (n=2036), those who did (n=326) were 24% less likely to have MVI and 27% less likely to develop tumor recurrence within 2 years, Feng Shen (Second Military Medical University, Shanghai) and co-investigators found.
The incidence of MVI was 38.7% in the patients who received AVT and 48.6% in those who did not, while the recurrences rates were 14.2% versus 23.4% at 6 months, 24.6% versus 37.1% at 1 year, and 38.5% versus 52.3% at 2 years.
Preoperative AVT was also associated with a significantly reduced risk for death (hazard ratio [HR]=0.75) during the median 44.8-month postoperative follow-up period, as well as a reduced risk for overall recurrence up to 5 years (HR=0.76) and a significantly decreased rate of multiple intrahepatic recurrences (36.2 vs 49.1%) and recurrences involving multiple hepatic segments (30.2 vs 41.3%) compared with no AVT.
Among the patients who did not meet the 90-day criteria for preoperative AVT, 147 received short-term treatment. The incidence of MVI and early recurrence in these patients was not significantly different from that observed in the non-AVT group.
The researchers also analyzed the association between HBV DNA level and MVI in the patients who did not receive AVT. They found that patients with a preoperative HBV DNA level of 2000 IU/mL or greater (n=1132) had a significantly higher incidence of MVI than those with a lower level, at 51.9% versus 44.5%, and an odds ratio of 1.40.
Shen and co-authors point out that “MVI is also closely associated with tumor recurrence after liver transplantation for HCC,” and therefore suggest that further studies should investigate “whether pretransplant AVT affects the incidence of MVI in viral-related HCC.”
In a commentary accompanying the study in JAMA Surgery, Yuman Fong, from City of Hope Medical Center in Duarte, California, USA, says: “Treating unrecognized viral infection is an effective way of preventing HCC.”
He adds: “Routine use of antiviral therapy should be considered after effective treatments for HCC as an overall strategy to optimize long term survival.”
By Laura Cowen
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