Association between nucleos(t)ide analog and tumor recurrence in hepatitis B virus–related hepatocellular carcinoma after radiofrequency ablation

Abstract

Radiofrequency ablation (RFA) is the best choice for curative treatment of hepatocellular carcinoma (HCC) cases not suitable for surgical intervention, but efforts should be made to reduce the risk of tumor recurrence. We aimed to investigate the association between nucleos(t)ide analog (NA) therapy for hepatitis B virus (HBV) and the risk of HCC recurrence post-RFA. Using the Taiwan National Health Insurance Research Database between July 1, 2004 and December 31, 2012, we screened 48,807 patients with newly diagnosed HBV-related HCC. We identified 850 patients (200 patients who used NAs for more than 90 days and 650 who never used NA post-RFA) who received RFA as a potentially curative treatment for HCC. Patients in the NA-treated cohort were randomly matched 1:2 with patients in the untreated cohort by age, sex, cirrhosis, and the time period between RFA and initiation of NA therapy. Finally, 133 patients were recruited in the NA-treated group and 266 in the untreated group for analysis. Cumulative incidences of and hazard ratios (HRs) for HCC recurrence were analyzed after adjusting for competing mortality. The HCC recurrence rate of the NA-treated group was significantly lower than that of the untreated group (2-year recurrence rate: 41.8%; 95% confidence interval [CI]: 32.9-50.6 vs. 54.3%; 95% CI: 48.0-60.6; modified log-rank test: P < 0.05). In modified Cox's regression analysis, NA therapy was independently associated with a decreased risk of HCC recurrence (HR, 0.69; 95% CI: 0.50-0.95; P < 0.05). Multivariate stratified analyses verified the association of NA therapy and decreased HCC recurrence in almost all patient subgroups. Conclusion: NA therapy was associated with a decreased risk of HCC recurrence among patients with HBV-related HCC post-RFA. (HEPATOLOGY 2016;63:1517-1527 SEE EDITORIAL ON PAGE 1415H epatocellular carcinoma (HCC) remains the third-most common cause of cancer death worldwide, and HCC-related deaths have been estimated to be approximately 700,000 per year.(1) With a low survival rate of less than 12% in 5 years, HCC is the fastest rising cause of cancer death in the United States.(2) Although HCC surveillance for high-risk populations may contribute to early tumor treatment and reduced mortality rates,the clinical outcomes of patients receiving curative

An HCC Aggressiveness Index and Blood GTP, Bilirubin and Platelet Levels

“…Nevertheless, the association is quite remarkable. Given the newly available and effective therapies for hepatitis B and C (and possibly also anti-inflammatory agent, such as aspirin, NSAIDS, Cox inhibitors, in patients without bleeding disorder), it may be that their use in suppressing hepatic inflammation and/or improving liver function in HCC patients with inflamed livers, offer the possibility of decreasing HCC aggressiveness through improvement of the underlying liver function [28][29][30][31][32]. What might be the mechanisms by which liver function parameters could influence HCC aggressiveness Two possible general explanations might be considered.…”

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

“…Recent studies demonstrate that oral antiviral treatment using nucleos(t)ide (nucleoside/nucleotide) analog results in favorable outcomes in terms of tumor recurrence and overall survival of HBV-related HCC after surgical resection [12–14]. However, a few studies have been carried out to explore on the effect of antiviral treatment on the prognosis of HBV-related HCC after curative RF ablation [15, 16]. Our group reported that the absence of antiviral therapy during follow up was associated with poor survival in HCC patients who received RF ablation as first-line therapy [15].…”

“…Our group reported that the absence of antiviral therapy during follow up was associated with poor survival in HCC patients who received RF ablation as first-line therapy [15]. Recently, Taiwanese investigators reported that nucleos(t)ide analog treatment is associated with a decreased risk of HCC recurrence using nationwide health insurance database [16]. However, previous studies did not provide detailed HBV-related data such as pretreatment HBV DNA levels or HBeAg status that are known as important factors affecting prognosis in HBV-related HCC.…”

Current clinical evidence for nucleos(t)ide analogues in patients with HBV-related hepatocellular carcinoma

“…Similarly, a cohort study of patients receiving curative liver resection for HCC in Taiwan demonstrated a significant risk reduction of tumor recurrence in patients receiving NAs versus untreated patients (45.6% vs. 54.6%, P < 0.001) [73]. This benefit was also seen following RFA (2-year recurrence rate: 41.8% vs. 54.3%; P < 0.05) [74].…”