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Antiviral therapy improves liver resection outcomes in patients with HBV

Patients with hepatitis B who underwent liver resection for intrahepatic cholangiocarcinoma had worse prognoses for viral reactivation, particularly those with high levels of HBV DNA, according to a recently published study. Preoperative antiviral therapy decreased viral reactivation and prolonged long-term survival.

“Preoperative [antiviral therapy (AVT)] reduced the incidence of postoperative viral reactivation, hepatitis and [postoperative liver failure],” Zhengqing Lei, MD, from the Second Military Medical University, China, and colleagues wrote. “The inhibitory role of preoperative AVT on postoperative viral reactivation also contributed to better short- and long-term prognosis.”

The researchers retrospectively analyzed data of 1,064 patients with HBV who underwent liver resection for ICC between January 2006 and December 2011 at two centers in China. To analyze surgical morbidity and long-term survival outcomes, the researchers formed a “short-term” cohort comprising 928 patients and a “long-term” cohort comprising 763 patients.

In the short-term cohort, 123 patients received preoperative AVT. Of those who did not receive preoperative AVT, 576 had HBV DNA levels less than 2,000 IU/mL and 229 had levels of 2,000 IU/mL or higher. Viral reactivation developed in 88 patients: 3.3% of patients who received preoperative AVT, 8.3% of untreated patients with low HBV DNA, and 15.7% of untreated patients with high HBV DNA.

Based on multivariate analysis, HBV DNA levels of 2,000 IU/mL or higher (OR = 1.85; 95% CI, 1.11-3.07), HBV e-antigen positivity (OR = 2.31; 95% CI, 1.21-4.4), no preoperative AVT (OR = 6.53; 95% CI, 2.19-19.44), operation time of 3 hours or longer (OR = 1.95; 95% CI, 1.15-3.31), hilar clamping time of 30 minutes or longer (OR = 2.98; 95% CI, 1.58-5.6), blood transfusion (OR = 2.57; 95% CI, 1.54-4.31) and adjuvant therapy (OR = 1.85; 95% CI, 1.13-3.03) correlated significantly with viral reactivation.

In the long-term cohort, 198 patients received preoperative AVT. Patients who did not receive preoperative AVT either had low viral levels (n = 419) or high viral levels (n = 146). Compared with untreated patients, those who received AVT were younger, had smaller median tumor size, were more often HBeAg-positive, and had a history of viral reactivation.

Multivariate analysis in the long-term cohort showed that high viral level (HR = 1.22; 95% CI, 1.01-1.47) and viral reactivation (HR = 1.34; 1.01-1.78) were significant risk factors for tumor recurrence.

Recurrence rates at 1, 3 and 5 years were not significantly different between patients in the long-term cohort who received AVT and those with low HBV DNA who did not. Recurrence rates were, however, significantly different between treated patients and untreated patients with high HBV DNA (P < .001) and between the untreated low and high HBV DNA groups (P = .017).

Overall, patients treated with AVT (HR = 0.6; 95% CI, 0.46-0.79) and those untreated but with low viral levels (HR = 0.76; 95% CI, 0.61-0.95) had decreased risks for tumor recurrence compared with untreated patients with high viral levels.

Similarly, patients treated with AVT had better cancer-specific survival rates (HR = 0.48; 95% CI, 0.36-0.64) and overall survival rates (HR = 0.56; 95% CI, 0.42-0.74) and untreated patients with low viral levels had better cancer-specific survival rates (HR = 0.63; 95% CI, 0.49-0.81) and overall survival rates (HR = 0.71; 95% CI, 0.56-0.91) compared with untreated patients with high viral levels.

“Previous studies have demonstrated a prognostic risk of high viral level, and the oncological advantage of AVT among patients with HBV-related [hepatocellular carcinoma (HCC)],” the researchers wrote. “In the current study, we demonstrated that a high viral level was associated with worse surgical outcomes among HBV-infected ICC patients, suggesting that HBV infection may play a role in both pathogenesis and prognosis among ICC patients with HBV infection.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.