Abstract
The ultimate goal of antiviral therapy for chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC). Earlier we reported favorable effects of antiviral therapy on survival of HCC patients following curative tumor ablation (Int J Cancer online 14 April 2010; doi: 10.1002/ijc.25382). It was the first observation made in the United States. We now report 12 year follow-up of this patient group. CHB patients with no prior antiviral therapy with a single HCC (≤7 cm) were studied. All patients underwent local tumor ablation as their first option. Patients diagnosed before 1999 received no antiviral treatment while those diagnosed after 1999 received antiviral treatment. Survival between the treated and untreated groups was compared. Among 555 HCC patients seen at our clinic between 1991 and 2013, 25 subjects were eligible. Nine subjects (all male patients, median age 53 years [46–66]) did not receive antiviral therapy while 16 (14 male patients, median age 56 years [20–73]) received treatment. Between the two groups, there was no difference in their median tumor size and levels of alpha-fetoprotein and albumin. However, the survival was significantly different (P = 0.001): the median survival of the untreated was 16 months (3–36 months) while that of the treated was 80 months (15–152 months). Fourteen of 16 treated patients are alive to date with two longest survivors alive for ≥151 months. In conclusion, concomitant antiviral therapy for CHB patients with HCC reduces and prevents new/recurrent tumor and improves survival. This novel treatment strategy offers an alternative to liver transplantation in patients with HBV-associated HCC.
Highlights
The ultimate goal of anti-HBV treatment for patients with chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC) as shown by prospective [1] and retrospective [2, 3] studies of a large number of CHB patients with advanced liver disease.The same goal can be applied for prevention of new and/or recurrent HCC in patients who had already developed HCC
Since 2005, we in the United States and researchers in Japan have reported that concomitant antiviral therapy with local tumor ablation reduced the new/recurrence of HCC in patients whose initial HCC was successfully ablated [4,5,6,7,8]
Among the 555 patients who presented with HCC at Liver Disease Prevention Center, Thomas Jefferson University Hospital between 1991 and 2013, all but one were Asian Americans with CHB with or without cirrhosis
Summary
The ultimate goal of anti-HBV treatment for patients with chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC) as shown by prospective [1] and retrospective [2, 3] studies of a large number of CHB patients with advanced liver disease. The same goal can be applied for prevention of new and/or recurrent HCC in patients who had already developed HCC. Since 2005, we in the United States and researchers in Japan have reported that concomitant antiviral therapy with local tumor ablation reduced the new/recurrence of HCC in patients whose initial HCC was successfully ablated [4,5,6,7,8]. Studies of large cohorts from Hong Kong in 2011
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