Abstract
The safety and efficacy of perioperative antiviral therapy for patients with hepatitis B virus related hepatocellular carcinoma and low serum levels of hepatitis B virus DNA are unknown. This retrospective study compared serum levels of hepatitis B virus DNA, liver function, morbidity, and length of hospital stay between patients who underwent hepatic resection alone and patients who received entecavir therapy before and after resection (n = 44 in each group). Propensity score matching was used to reduce confounding due to baseline differences between the groups. Hepatitis B virus reactivation during follow-up, which lasted a median of 6.1 months, occurred in one patient in the entecavir group (2.3%) and 11 patients in the resection-only group (25%; P = 0.02). Liver function, especially alanine aminotransferase levels, recovered much faster in the entecavir group. This group also showed a slightly lower rate of morbidity (P = 0.081) as well as significantly shorter overall hospital stay (20.1 ± 4.9 vs 24.9 ± 13.2 days; P = 0.028) and postoperative hospital stay (11.4 ± 1.9 vs 16.8 ± 13.1 days; P = 0.008). These results from this pilot study suggest that patients with hepatitis B virus related hepatocellular carcinoma and low levels of hepatitis B virus DNA are at risk of hepatitis B virus reactivation following resection, and that perioperative entecavir therapy can safely and effectively reduce this risk. Such therapy also appears to improve liver function and shorten hospitalization.
Highlights
Hepatitis B virus (HBV) infection is a global health challenge
Whether perioperative entecavir therapy is safe and effective for patients with low serum levels of HBV DNA is unknown. In this small retrospective study involving propensity score-matched patients, we found entecavir therapy to be safe and effective at reducing occurrence of HBV reactivation, improving liver function recovery, reducing postoperative morbidity and shortening hospital stay
The most widely-used definition of HBV reactivation is an abrupt rise in HBV DNA levels by at least 1 log10 from baseline [27]
Summary
Hepatitis B virus (HBV) infection is a global health challenge. In addition to being a serious infection, it is a major risk factor for death from cirrhosis and hepatocellular carcinoma (HCC) [1,2]. Whether the same is true for patients with HBV-related HCC and low levels of HBV DNA is unclear [18,19], and current official guidelines do not recommend antiviral therapy for such patients [20,21,22,23]. This retrospective study aimed to investigate whether perioperative entecavir antiviral therapy could reduce the risk of HBV reactivation after hepatic resection in patients with HBV-related HCC and low serum levels of viral DNA. In comparing patients who underwent hepatic resection with or without perioperative entecavir therapy, we analyzed propensity score-matched patient pairs in order to reduce confounding from baseline differences
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