Recurrent Hepatocellular Carcinoma: It's the Virus!

Abstract

influence the incidence of HCC recurrence, antiviral treatment and preoperative serum HBV DNA were found to have a significant impact on postoperative recurrence and subsequent death. While these results, particularly those of the randomized trial, are exciting and significant, the study has limitations. Inexplicably, the randomization failed to balance important aspects of the two study arms. Patients who were assigned to no antiviral treatment had a significantly higher proportion of incomplete or no tumor encapsulation (73% v 53%), poor differentiation (81 v 62%) and increased serum alpha fetoprotein ( 20 ng/mL, 72% v 57%). On the other hand, patients who were assigned to receive antiviral therapy were enriched with uninodular tumors (88% v 72%), small ( 3 cm) lesions (14% v 6%), and low Barcelona Clinic Liver Cancer stage tumors (0 or A, 88% v 73%), although these differences did not reach statistical significance. These characteristics place patients in the antiviral group at a lower risk of tumor recurrence with a potential for clinical benefits associated with antiviral therapy. A subsequent post hoc multivariable analysis may not necessarily correct the inherent differences between the two arms. As one considers the validity of the conclusion of the study and questions how antiviral therapy may reduce the incidence of HCC, it is