Perioperative entecavir for patients with HBV-related hepatocellular carcinoma and low levels of viral DNA: analysis using propensity score matching

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.

GSTM1 and GSTT1 null genotype increase the risk of hepatocellular carcinoma: evidence based on 46 studies

“…This could be explained by the potential possibility that the African and Caucasian may have certain unknown repair mechanism to avoid the damage caused by deficiency of the GSTM1 gene. It is said that the infection of HBV can easily evolve to liver cirrhosis and finally to HCC [63]. In addition, foodstuffs polluted with aflatoxin B1 (AFB1) are also a threat to livers.…”

Risk of HBV reactivation during therapies for HCC: A systematic review

“…HBV reactivation was defined as an increase of serum HBV DNA > 1 log or reappearance of HBV DNA in patients with undetectable HBV DNA at baseline in 33 studies, [ 19–21,23–30,32–36,38–43,45–48,50–53,56–58 ] while this definition varied in five studies [ 31,44,49,55,59 ] and was not clearly provided in the remaining three studies. [ 22,37,54 ] A definition of HBV‐related biochemical reactivation was not provided in 18 studies, [ 21–27,30,32–34,37–41,54,59 ] while it varied widely among the remaining 23 studies. [ 19,20,28,29,31,35,36,42–53,55–58 ] Only increases in aminotransferase levels attributed to HBV reactivation by the authors were considered HBV‐related biochemical reactivation.…”

“…Rates of HBV reactivation (A, all patients; B, patients without prophylactic HBV therapy; C, patients with prophylactic HBV therapy) and biochemical exacerbation (D) in studies including HBsAg‐positive patients with HCC who underwent surgical resection for HCC (Kubo et al, [ 55 ] Jang et al, [ 19 ] Thia et al, [ 56 ] G. Huang et al, [ 57 ] Lao et al, [ 58 ] Dan et al, [ 53 ] Lee et al, [ 59 ] Sohn et al, [ 21 ] Zhang et al, [ 22 ] Xie et al, [ 23,25 ] Chen et al, [ 24 ] Gong et al, [ 26 ] Yuan et al, [ 27 ] S. Huang et al, [ 28 ] Z. Li et al, [ 29 ] X.‐B. Wang et al, [ 30 ] Xu et al, [ 32 ] C. Li et al, [ 33 ] Z.‐Y.…”

“…[ 21,22,23–28,30,32,33,34,53,54,57–59 ] The pooled rates of HBV reactivation were 16% (95% CI, 13%–20%; heterogeneity, p = 0.06) in eight studies with mean/median follow‐up ≤6 months [ 22–27,30,59 ] and 16% (95% CI, 10%–26%; heterogeneity, p < 0.01) in seven studies with mean/median follow‐up >6 months. [ 19,21,28,32,55–57 ] Patients receiving entecavir prophylaxis had a pooled HBV reactivation rate of 2% (95% CI, 1%–4%; heterogeneity, p = 1.00), [ 22–27,32,33 ] compared to 4% (95% CI, 1%–22%; heterogeneity, p < 0.01) for those receiving other NAs, most commonly lamivudine. [ 28,34,57–59 ] Biochemical reactivation was reported in 11.0% (289/2629) of patients in seven studies [ 19,28,55–59 ] (pooled estimate, 6%; 95% CI, 3%–12%; heterogeneity, p < 0.01) (Figure 3D), but data in relation to prophylactic NA use were not provided in most studies.…”

The different effects of adefovir dipivoxil and telbivudine on the prognosis of hepatitis b virus-related hepatocellular carcinoma patients after curative resection

“…[7] Studies of large cohorts from China Hong Kong, China Taiwan, and Japan have confirmed that concomitant antiviral therapy with curative treatment reduced the recurrence of HCC. [8–11] However, there was no consensus about which kind of oral antiviral treatment was the best option in the prevention of HBV related HCC recurrence after curative treatment. Therefore, we conducted this study to investigate the different effects of adefovir dipivoxil (ADV) and telbivudine (LdT) on the prognosis of HBV-related HCC after curative resection.…”