Antiviral therapy predicts the outcomes following resection of hepatocellular carcinoma in patients negative for HBV DNA: a propensity score matching analysis

Mingxing Xu,Zheng Zhou,Nan Lin,Ruiyun Xu,Huiling Zhang,Yuesi Zhong

doi:10.1186/s12957-019-1577-9

Abstract

BackgroundThe effect of antiviral therapy (AVT) on clinical outcomes in patients with hepatocellular carcinoma (HCC) who are seronegative for hepatitis B virus (HBV), defined as HBV DNA < 100 IU/ml prior to surgical resection, is unknown. The main purpose of this study was to evaluate the possible value of AVT in this cohort of patients.MethodsFrom January 2006 to January 2013, 161 HCC patients with positive serum tests for HBV surface antigen (HBsAg) but negative tests for HBV DNA who had undergone hepatectomy were included and analyzed. Propensity score matching (PSM) was used to balance the heterogeneity in baseline characteristics.ResultsAll patients were divided into the following two groups: the AVT group (n = 73, 45.34%) and the non-AVT group (n = 88, 54.66%). HBV reactivation occurred in 20 patients in the non-AVT group (22.73%) but in only 2 patients in the AVT group (2.74%, p < 0.001). After PSM, the 1-, 2-, and 3-year recurrence-free survival (RFS) rates in the AVT group and the non-AVT group were 78.38%, 72.97%, and 62.16% and 81.08%, 72.97%, and 72.97%, respectively (p = 0.564); the 1-, 2-, and 3-year overall survival (OS) rates were 97.30%, 97.3%, and 91.89% and 94.59%, 94.59%, and 86.49% in the AVT group and non-AVT group, respectively (p = 0.447).ConclusionsAntiviral therapy can reduce HBV reactivation but is not correlated with a significant increase in postoperative RFS and OS in HCC patients with HBV DNA levels < 100 IU/ml.

Highlights

The effect of antiviral therapy (AVT) on clinical outcomes in patients with hepatocellular carcinoma (HCC) who are seronegative for hepatitis B virus (HBV), defined as HBV DNA < 100 IU/ml prior to surgical resection, is unknown
The present study evaluated the rate of post-hepatectomy HBV reactivation in HBV DNA-negative patients and explored the potential value of AVT for improving patient survival; the hypothesis was that AVT would be beneficial for HBV DNA-negative HCC patients (HBV DNA < 100 IU/ml)
All patients were negative for hepatitis C virus (HCV) antibodies; did not receive adjuvant treatments, such as systemic chemotherapy, postoperative adjuvant transcatheter arterial chemoembolization (TACE) or transcatheter arterial embolization (TAE), and adoptive immunotherapy; had only HCC; and had the diagnosis of HCC pathologically confirmed after the surgery

Summary

Introduction

The effect of antiviral therapy (AVT) on clinical outcomes in patients with hepatocellular carcinoma (HCC) who are seronegative for hepatitis B virus (HBV), defined as HBV DNA < 100 IU/ml prior to surgical resection, is unknown. Previous studies have indicated that AVT can reduce the risk of virus reactivation, help improve liver function in patients with low levels of HBV DNA (HBV DNA < 500 IU/ml) after HCC surgery [15], and reduce HCC recurrence in patients with low HBV DNA levels (HBV DNA < 2000 IU/ml) [16]. Whether AVT is useful in HCC patients who test negative for HBV DNA (HBV DNA < 100 IU/ml) to improve their clinical outcomes is still unknown, as evidence is lacking

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