Effects of antiviral therapy on the recurrence of hepatocellular carcinoma after curative resection or liver transplantation

Abstract

Context: Hepatocellular carcinoma (HCC) is a fatal disease. Chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is the major cause of HCC. High viral replication rate and related hepatic/systematic inflammation are the major risk factors in HCC recurrence after hepatectomy or liver transplantation.

Evidence acquisition: Some of the carcinogenesis-related HBV mutations are also associated with poor prognosis for HCC patients. Antiviral therapy is an option for improving HCC prognosis after surgery. In case of HBV-associated HCC, treatment with interferon and nucleos(t)ide analogues (NAs), especially interferon, is effective in improving the prognosis. However, long-term use of NAs increases the possibility of developing drug-resistant viral mutations such as the HBV rtA181T/sW172 mutation, which increases the risk of HCC recurrence.

Results: In cases of HCV-associated HCC, standard interferon with or without ribavirin therapy is effective in improving the prognosis of HCV-associated HCC; however, some HCV mutations, such as the amino acid substitution M91L, are associated with treatment failure and a poor prognosis. Therapeutic efficacy needs to be confirmed using largescale, randomized, placebo-controlled clinical trials.

Conclusions: Surveillance of viral mutations during antiviral treatment and a better understanding of the associations of HCC recurrence with viral load, inflammation-associated signaling, and environmental factors can aid the development of more effective strategies for the prevention of HCC recurrence after surgery.

Keywords: Carcinoma; Hepatocellular; Operative; Recurrence; Surgical Procedures; Survival.

Figure 1. Major Events in HBV Hepatocarcinogenesis and HBV-Related HCC Prognosis

HBIG, Hepatitis B Immune Globulin; HBV, Hepatitis B virus; HCC, Hepatocellular Carcinoma; IFN, Interferon; NA, Nucleos (t)ide Analogue

Figure 2. Major Events in HCV Hepatocarcinogenesis and HCV-Related HCC Prognosis

HCC, Hepatocellular Carcinoma; HCV, hepatitis C Virus; SVR, Sustained Virologic Response