Antiviral Therapy Lowers Risk of HBV-Related Hepatocellular Carcinoma Recurrence

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(ChemotherapyAdvisor) – Use of a nucleoside analogue was associated with a lower risk of recurrence of hepatocellular carcinoma (HCC) among patients with hepatitis B virus (HBV) after curative liver resection, a study in the November 14 issue of JAMA has found. The study was released early online to coincide with its presentation at the annual meeting of the American Association for the Study of Liver Diseases.

Chun-Ying Wu, MD, PhD, MPH, of National Yang-Ming University, Taipei, Taiwan, and colleagues identified 4,569 patients with HBV-related HCC from among more than 100,000 newly diagnosed with HCC in the Taiwan National Health Insurance Research Database who had received a curative liver resection between October 2003 and September 2010.

Risk of first tumor recurrence was compared between those not taking nucleoside analogue antiviral therapy (n=4051) and the treated cohort (n=518).

Compared with the untreated cohort, those treated with nucleoside analogues had a higher prevalence of liver cirrhosis, 48.6% vs 38.7% (P<0.001); however, they also had a lower risk of HCC recurrence, 20.5% vs 43.6% (P<0.001), and lower overall death, 10.6% vs 28.3% (P<0.001).

After adjusting for competing mortality, the treated cohort had a significantly lower rate of HCC recurrence at 6 years, 45.6%, vs 54.6% for those untreated (P<0.001). Overall mortality at 6 years was 29.0% for the treated and 42.4% for the untreated cohort (P<0.001).

After analysis, use of a nucleoside analogue was associated with a 33% reduced risk of HCC recurrence; statins, a 32% reduced risk; and nonsteroidal anti-inflammatory drugs or aspirin, a 20% reduced risk. Further analyses verified the association in all subgroups of patients, including those who were noncirrhotic and diabetic.

An accompanying editorial noted, “the results of this study support findings from multiple smaller studies but are by no means definitive enough to answer the question of whether antiviral therapy after curative resection of hepatitis B-related HCC will prevent disease recurrence.”

“Given the long interval between cell damage, malignant transformation, and tumor development, it is unrealistic to expect that administration of antiviral therapy for 1 to 2 years can prevent HCC recurrence, particularly because early recurrence is likely due to previously undiscovered metastasis from the primary tumor. However, nucleoside/nucleotide analogues may decrease short-term mortality after liver resection, particularly among patients with underlying cirrhosis, high levels of HBV replication, or active hepatic inflammation. For patients who do not experience early HCC recurrence, continued therapy with nucleoside/nucleotide analogues may prevent de novo primary tumors and further progression of liver disease, thereby decreasing late HCC recurrence and long-term mortality.” Abstract

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