Impact of Antiviral Therapy on the Survival of Patients After Major Hepatectomy for Hepatitis B Virus-Related Hepatocellular Carcinoma

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http://archsurg.ama-assn.org/cgi/content/abstract/146/6/675

Impact of Antiviral Therapy on the Survival of Patients After Major Hepatectomy

for Hepatitis B Virus–Related Hepatocellular Carcinoma

Albert C. Y. Chan, MBBS, FRCS; S. H. Chok, MBBS, FRCS; Wai Key Yuen,

MBBS, FRCS; See Ching Chan, FRCS, MS; Ronnie T. P. Poon, MS, PhD; Chung Mau Lo,

FRCS, MS; Sheung Tat Fan, MS, MD, PhD, DSc, FRCS, FACS

Arch Surg. 2011;146(6):675-681. doi:10.1001/archsurg.2011.125

Objectives: To assess whether commencement of antiviral therapy after

hepatectomy improves the prognosis of hepatocellular carcinoma (HCC) in

preoperatively antiviral-naive patients with chronic hepatitis B virus (HBV)

infection.

Design :Retrospective analysis of a prospectively collected database.

Setting: University teaching hospital.

Main Outcome Measures: Disease-free and overall survival rates.

Results: One hundred thirty-six patients received major hepatectomy for

HBV-related HCC from September 1, 2003, through December 31, 2007. Among them,

42 patients received antiviral therapy (treatment group) after hepatectomy,

whereas 94 did not (control group). Patient demographics, preoperative liver

function, tumor characteristics, and liver function at the time of tumor

recurrence were comparable between the 2 groups. Disease-free and overall

survival rates were significantly prolonged in the treatment group. The 1-, 3-,

and 5-year overall survival rates in the treatment group were 88.1%, 79.1%, and

71.2%, respectively; in the control group, 76.5%, 47.5%, and 43.5%, respectively

(P = .005). The 1-, 3-, and 5-year disease-free survival rates in the treatment

group were 66.5%, 51.4%, and 51.4%, respectively; in the control group, 48.9%,

33.8%, and 33.8%, respectively (P = .05). Subgroup analysis stratified against

tumor stage and major vascular invasion showed that posthepatectomy antiviral

treatment conferred a significant survival benefit in stages I and II tumors or

HCCs without major venous invasion.

Conclusions: Antiviral therapy improves the prognosis of HBV-related HCC. It

should be considered after hepatectomy for HBV-related HCC, especially in

early-stage tumors.

Author Affiliations: Department of Surgery, The University of Hong Kong, Queen

Hospital, Hong Kong Special Administrative Region.