Abstract
BackgroundIt remains unclear what the antiviral therapy affects disease-free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels. In this study, we analyzed the association of antiviral treatment with DFS and OS based on the stratification of baseline HBV DNA load in early-stage (stages I and II) HCC patients.MethodsWe included 445 patients with early-stage HBV-related HCC who underwent curative resection, and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification. The Kaplan–Meier and Cox regression analyses were performed to determine the association of clinical characteristics with survival.ResultsThe median follow-up period was 74 months. For all patients, cumulative OS rates in the antiviral group were significantly higher than those in the non-antiviral group (log-rank test, P = 0.023), whereas no significant differences in DFS rates were observed. High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients. In patients with baseline HBV DNA levels ≥2000 IU/mL, antiviral treatment was significantly associated with prolonged DFS and OS (log-rank test, P = 0.041 and 0.001, respectively). In patients with HBV DNA levels <2000 IU/mL or undetectable, antiviral treatment did not show a significant benefit in prolonging DFS and OS.ConclusionsHigh baseline HBV DNA levels are associated with poor prognosis in the patients with early-stage HCC, and the antiviral treatment could generate survival benefits for the patients. Therefore, antiviral treatment should be given for these patients. However, the effect of antiviral treatment on the patients with low viral load remains unclear, and further investigation is warranted.
Highlights
It remains unclear what the antiviral therapy affects disease-free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels
High levels of serum HBV DNA are associated with an increased risk of developing HCC [4], and nomograms based on clinical characteristics, including serum hepatitis B e antigen (HBeAg) status and HBV DNA level, can predict the risk of developing HCC [5]
In the present study, we found that baseline HBV DNA level was a significant prognostic factor that influenced both OS and DFS of early-stage HCC patients undergoing curative resection, which was consistent with the findings of most previous studies [24,25,26,27]
Summary
It remains unclear what the antiviral therapy affects disease-free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels. We analyzed the association of antiviral treatment with DFS and OS based on the stratifi‐ cation of baseline HBV DNA load in early-stage (stages I and II) HCC patients. Most HCCs develop within an established background of chronic liver disease, and the most common risk factor for HCC is hepatitis B virus (HBV) infection [3]. In HBV-related HCC, high levels of serum HBV DNA appear to be associated with poor prognosis [6,7,8]. Careful management of HBV infection is needed in the management of HBV-related HCC [9]
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