218 SUPPRESSIVE EFFECTS OF ENTECAVIR ON VIRAL REPLICATION AND TUMOR PROLIFERATION IN PATIENTS WITH HEPATITIS B VIRUS-RELATED HEPATOCELLULAR CARCINOMA

Abstract

Background and Aims: Lamivudine had comparable antiviral effects both in patients with chronic hepatitis B (CHB) and hepatits B virus (HBV)-related hepatocellular carcinoma (HCC). We aimed to investigate the antiviral and antitumoural effects of entecavir (ETV) in HBV-related HCC patients. Methods: From January 2007 to December 2007, 271 chronically HBV-infected patients were primarily treated with ETV 0.5mg/day for at least 6 months in our institution. Among these, 94 had HCC at the initiation of ETV treatment (HCC group) and 177 did not (non-HCC group). We compared antiviral responses to ETV between the two groups, and also evaluated the influence of ETV on post-treatment outcomes of HCC. Results: At baseline, the HCC group was older, and had higher Child–Pugh score and liver cirrhosis rate than the non-HCC group (all P < 0.05). 33% of the HCC group and 62% of the nonHCC group were positive for Hepatitis B e antigen (HBeAg) (P < 0.05). There were no differences in serum HBV DNA and alanine aminotransferase (ALT) levels between the two groups. The cumulative rates of HBV DNA negativity (<300 copies/ml), ALT normalization, and HBeAg loss at 48 weeks were similar for both groups (86.2%, 85.1% and 43.8%, respectively for the HCC group and 81.4%, 87.6% and 36.4%, respectively for the non-HCC group). After 48 weeks, the HCC group showed significant decreases in mean Child–Pugh and MELD scores, compared with baseline (6.9 vs. 5.8 and 10.1 vs. 8.7, respectively; both P < 0.001). Of the 94 HCC patients, 33 received curative therapies for HCC, simultaneously with ETV: hepatectomy in 9 and radiofrequency ablation in 24. For these subgroup, median recurrence-free survival was 27.9 months in the 21 patients who achieved HBV DNA negativity at week 24, significantly longer than 17.6 months in those who did not (27.9 vs. 17.6 months, P = 0.01), similar to overall survival (P = 0.067): all pretreatment characteristics of patients and tumors did not differ. Conclusions: First-line ETV was comparably efficacious in either CHB patients with or without HCC. ETV treatment improved hepatic function in HCC patients, and early virological response to ETV markedly produced a delay of post-treatment recurrence of HCC.