Association of Prophylactic Anti–Hepatitis B Virus Therapy With Improved Long-term Survival in Patients With Hepatocellular Carcinoma Undergoing Transarterial Therapy

Abstract

Background The effect of prophylactic antiviral therapy (AVT) on survival of patients with hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) remains unknown. This study aimed to determine whether prophylactic AVT could improve long-term survival in patients undergoing transarterial chemotherapy (TAC). Methods Between 2002 and 2016, 2860 newly diagnosed HBV-related patients with HCC treated with TAC were screened to analyze 2 groups based on prophylactic use of antivirals. Treatment effects were analyzed using propensity score (PS) matching (1:1) separately for the entire cohort and each subgroup. The primary endpoint was overall survival. Results A total of 1547 patients met the inclusion criteria and 1084 were PS matched for the 2 groups. Median follow-up duration was 16.55 months. In the entire unmatched cohort, patients receiving prophylactic AVT survived significantly longer than those who did not. Among AVT-untreated patients, baseline high viremia and HBV reactivation during treatment were significantly associated with shorter survival. Regarding types of antivirals, survival was significantly longer for patients receiving high-potency antivirals than those receiving low-potency antivirals. Survival differed with antiviral response. In the PS-matched cohort, the prophylactic AVT group survived significantly longer than the nonprophylactic group, irrespective of viral status or tumor stage. Prophylactic AVT remained an independent factor for survival. The association of prophylactic AVT with decreased risk of mortality persisted in patient subgroups after adjusting for baseline risk factors. Sensitivity analyses also confirmed estimated treatment effects. Conclusions Prophylactic AVT is associated with significantly improved long-term survival among patients undergoing TAC. High-potency antivirals are indicated for this approach. Hepatitis B virus–associated morbidity is a well-known complication during transarterial chemotherapy (TAC). Our large-scale study demonstrated that prophylactic therapy with high-potency antivirals provides a significantly better survival in TAC-treated patients, irrespective of baseline viremia status or tumor stage.

Association of Virological Response to Antiviral Therapy With Survival in Intermediate-Stage Hepatitis B Virus-Related Hepatocellular Carcinoma After Chemoembolization

“…In the current study, we found that nearly 60% HBV-HCC patients with a high viral load pre-TACE achieved VR after NA therapy. Moreover, our findings suggest that NA therapy with achievement of VR improves OS after TACE for HBV-HCC, which is consistent with a recent study reported by Jang and colleagues (18).…”

“…In addition, HCC patients undergoing TACE can benefit from NA therapy as reported in the previous studies (16,17). Recently, a large-scale study has revealed that prophylactic antiviral therapy is associated with better long-term survival among HBV-HCC patients undergoing TACE (18).…”

“…Another study has demonstrated that a high pre-TACE HBV DNA level has been correlated with poor OS and rapid disease progression after TACE (11), indicating the importance of long-term antiviral therapy for long-lasting suppression of HBV replication to prevent HCC progression. Furthermore, several studies have shown that NA therapy could reduce the risk of deterioration of hepatic function (16,31,32) or improve survival outcomes in patients with HBV-HCC undergoing TACE (17,18).…”

“…Furthermore, chronic hepatitis B cirrhotic patients with maintained undetectable HBV DNA levels after NA therapy had better transplant-free survival outcomes (21). These findings highlight the importance of VR status after NA therapy on survival outcomes of HCC patients with anti-tumor treatment, but only one recent research has proposed that survival differed with antiviral response in HBV-HCC patients after TACE (18). However, it remains less clear whether the status of maintained virological response (MVR) when compared to low-level viremia or persistent detectable HBV DNA level has benefits for postponing HCC progression after TACE.…”

Antiviral Therapy Reduces Mortality in Hepatocellular Carcinoma Patients with Low-Level Hepatitis B Viremia

“…Several studies have reported that antiviral therapy including TACE and RFA is minimally invasive, can improve the survival rate, and reduce the recurrence rate after resection. [4][5][6][7][8][9][10][11][12][13][14] Therefore, it is recommended that HBVassociated HCC patients, particularly those with high viral loads, receive antiviral therapy. A retrospective cohort study recently revealed that 19.9% of chronic hepatitis B(CHB) patients had low-level viremia (LLV; 20-2000 IU/mL) after entecavir (ETV) treatment.…”