Abstract
Data on the impact of antiviral therapy(AVT) on the long-term outcomes of hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC) patients with historically-proved cirrhosis after hepatectomy are limited. We aimed to determine the effect of AVT on resected HCC in the background of HBV-related cirrhosis. A total of 1396 patients with HBV-related cirrhotic HCC undergoing curative resection were categorized into AVT and no-AVT groups retrospectively. Recurrence rates were compared, especially according to the initiation time of AVT, virological response, and low HBV levels. Early and late recurrence was stratified by 2 years postoperatively. The 1-, 3-, 5- and 10-year recurrence rates in AVT group(n=432) were lower than those in no-AVT group(n=964, 26%, 49%, 65% and 76% vs. 29%, 69%, 87% and 92%,p<0.001). AVT was an independent factor for late, but not early, recurrence(p<0.001). The late recurrence rates were similar between patients with only postoperative AVT and those with both pre-and postoperative AVT(p=0.772). In the AVT group, the late recurrence rates in patients with persistent virological response(PVR) were lower than those in patients with low detectable viral levels(LDV, p=0.003). Logistic regression analysis showed that the time to virological response(p<0.001) and HBeAg positivity(p<0.001) were independently associated with LDV. Patients with spontaneous or treatment-induced undetectable HBV showed the lowest and similar late recurrence rates(p=0.796). Results were similar in multiple sensitivity analyses. Long-term AVT, regardless of preoperative or postoperative initiation, reduced post-resection late recurrence in patients with HCC and cirrhosis, especially in those with PVR.
Published Version
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