Risk of recurrence in chronic hepatitis B patients developing hepatocellular carcinoma with antiviral secondary prevention failure.

I-Cheng Lee,Gar-Yang Chau,Han-Chieh Lin,Ming-Chih Hou,Yi-Hsiang Huang,Teh-Ia Huo,Chien-Wei Su,Yee Chao,Yi-Chen Yeh,Yujin Hoshida

doi:10.1371/journal.pone.0188552

Abstract

BackgroundNucleos(t)ide analogues (NUCs) treatment can reduce the risk of hepatocellular carcinoma (HCC) development and recurrence in chronic hepatitis B (CHB) patients. However, the risk of recurrence in CHB patients who develop HCC despite NUC treatment remains unclear.Methods167 consecutive CHB patients receiving curative resection for HCC with NUC therapy after surgery were retrospectively enrolled. Thirty-eight patients who developed HCC despite NUC therapy for more than 1 year were defined as secondary prevention failure. The other 129 patients started NUC therapy after surgery. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were evaluated.ResultsThe 5-year RFS and OS rates were 44.7% and 77.3%, respectively. Sex, BMI, BCLC stage, AFP levels and cirrhosis status were the independent predictors of RFS, while microvascular invasion was the independent predictor of OS. The RFS was comparable between patients with and without NUC secondary prevention. In the subgroup analysis, the RFS was significantly worse in cirrhotic patients with secondary prevention failure (hazard ratio = 2.373, p = 0.009). Secondary prevention failure did not have adverse impact on OS. Among 84 patients with recurrence, 58.3% of the cases remained in BCLC stage A, and 53.6% received a second curative treatment. Long-term NUC therapy may lead to a decline of non-invasive indices of hepatic fibrosis in HCC patients.ConclusionsIn general, the risk of recurrence and survival are comparable between patients with and without secondary prevention failure. However, a higher risk of recurrence was observed in cirrhotic patients with secondary prevention failure.

Highlights

Despite the improvement in controlling risk factors and surveillance, hepatocellular carcinoma (HCC) remains the third leading cause of cancer-related deaths in the world [1]
BMI, Barcelona Clinic Liver Cancer (BCLC) stage, AFP levels and cirrhosis status were the independent predictors of recurrence-free survival (RFS), while microvascular invasion was the independent predictor of overall survival (OS)
The RFS was comparable between patients with and without nucleos(t)ide analogue (NUC) secondary prevention

Summary

Introduction

Despite the improvement in controlling risk factors and surveillance, hepatocellular carcinoma (HCC) remains the third leading cause of cancer-related deaths in the world [1]. Nucleos(t)ide analogues (NUCs), which may suppress viral replication, attenuate the progression of liver disease, and reverse liver fibrosis and cirrhosis, are the mainstay of the treatment for chronic hepatitis B (CHB) [5,6]. NUC treatment has been reported to attenuate 52%-78% of the risk of HCC development in patients with CHB, and may be adopted as a secondary preventive strategy for HBV-related HCC (secondary prevention) [7,8]. Male gender, advanced liver disease, diabetes mellitus (DM) and not achieving virological response (VR) have been shown to be predictors of HCC development in CHB patients under NUC therapy [12,14,15]

Objectives

Methods

Results

Conclusion