This article is more than 5 years old. Information may no longer be current.
Antiviral therapy reduced risk for HBV-related tumor recurrence after liver resection
Click Here to Manage Email Alerts
Among patients who had liver resection for hepatitis B-related hepatocellular carcinoma, the use of nucleoside analogues reduced the risk for tumor recurrence, recent data published in The Journal of the American Medical Association suggest.
“The high tumor recurrence rate in these patients highlights the need for the use of antiviral drugs for tertiary prevention,” Chun-Ying Wu, MD, PhD, MPH, of the School of Medicine at National Yang-Ming University in Taipei, told Infectious Disease News. “According to this nationwide long-term observation, we strongly recommend starting nucleoside analogue treatment as a standard of care for patients after HBV-related hepatocellular carcinoma resection to reduce recurrence and improve the patient’s overall survival.”
Chun-Ying Wu
Wu and colleagues conducted a nationwide cohort study between October 2003 and September 2010. The researchers used data from the Taiwan National Health Insurance Research Database. The study included 4,569 patients with HBV-related hepatocellular carcinoma that received curative liver resection during the study time period. The researchers compared the risk for tumor recurrence between 4,051 patients who did not take nucleoside analogues and 518 patients who did.
Among those who received the drugs, the incidence of tumor recurrence was 20.5% vs. 43.6% for those who did not receive the drugs. These patients also had a lower risk for death: overall, 10.6% of treated patients died vs. 28.3% of untreated patients. When adjusted for competing mortality, the 6-year recurrence rate was 45.6% among treated patients vs. 54.6% for untreated patients. The treated patients had a higher prevalence of liver cirrhosis compared with untreated patients (48.6% vs. 38.7%).
On a multivariable analysis, the use of statins, nonsteroidal anti-inflammatory drugs or aspirin was associated with lower risk for recurrence. Liver cirrhosis was an independent risk factor for recurrence.
“Several issues should be answered in the future,” Wu said. “First, the mean duration of nucleoside analogue use in the present study was 1.5 years. Whether longer duration of nucleoside therapy will further diminish the risk of tumor recurrence is an important question. Second, further studies to explore the roles of statins and NSAIDs in the prevention of recurrence and their interactions with nucleoside analogues will be helpful to further reduce tumor recurrence rate. Third, it will be important to identify the population at highest risk for recurrence after using nucleoside analogues and investigate the underlying pathogenesis.”
In an accompanying editorial, Anna S. F. Lok, MD, professor of hepatology at the University of Michigan, wrote that although this study supports findings from smaller studies, they do not definitively answer whether nucleoside analogues 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 hepatocellular carcinoma recurrence, particularly because early recurrence is likely due to previously undiscovered metastasis from the primary tumor. However, the 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 more information:
Lok A. JAMA. 2012;doi:10.1001/2012.jama.12971.
Wu C. JAMA. 2012;doi:10.1001/2012.jama.11975.
Disclosure: Wu and the researchers report no relevant financial disclosures. Lok reports financial relationships with Arrowhead, Bayer, Bristol-Myers Squibb, Gilead, GlaxoSmithKline and Roche.