Effects of antiviral therapy on preventing liver tumorigenesis and hepatocellular carcinoma recurrence

Abstract

Chronic hepatitis B virus (HBV) infection is the key driving force of liver disease progression, resulting in the development of hepatic dysfunction, cirrhosis and hepatocellular carcinoma (HCC). The primary aim of therapy is to suppress or eliminate HBV replication to reduce the activity of hepatitis, thus reducing the risk of, or slowing the progression of, liver disease. Nucleos(t)ide analogues (Nucs) may result in rapid suppression of HBV replication with normalization of serum transaminases and restore liver function, thus increasing survival in patients with hepatic decompensation. Long-term Nuc therapy may result in histological improvement or reversal of advanced fibrosis and reduction in disease progression, including the development of HCC. The long-term benefits of a finite course of interferon (IFN)-α therapy also include a sustained and cumulative response, as well as hepatitis B surface antigen seroclearance and reduction in the development of cirrhosis and/or HCC. Pegylated IFN and newer Nucs may achieve better long-term outcomes because of improved efficacy and a low risk of drug resistance. However, treatment outcomes are still far from satisfactory. Understanding the effects of anti-HBV treatment against HCC incidence and recurrence after hepatectomy or liver transplantation is required for further improvement of outcome.

Keywords: Antiviral therapy; Carcinogenesis; Clinical trial; Hepatocelluar carcinoma; Interferon; Nucleos(t)ide analogues; Recurrence; Retrospective study.

Figure 1

Comparison of hepatocellular carcinoma recurrence and outcome in patients who received anti-hepatitis B virus therapy or placebo after hepatectomy or liver transplantation. A: From September 2009 to May 2010, 224 HCC patients who received partial hepatectomy due to HBV-related HCC were enrolled. HCC recurrence and 3-year overall survival rate in patients with anti-HBV treatment (n = 173) and patients without standardized anti-HBV treatment (n = 51) were monitored for at least 3 years. Left: log-rank test, P = 0.013; right: log-rank test, P = 0.006; B: From January 2010 to August 2011, 42 HCC patients within Milan criteria who received liver transplantation were enrolled. HCC recurrence and 2-year overall survival rate in patients with anti-HBV treatment (n = 28) and patients without standardized anti-HBV treatment (n = 14) are shown. Left: log-rank test, P = 0.031; right: log-rank test, P = 0.045. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus.