• Antiviral therapy
• HBV reactivation
• Hepatitis B virus
• Hepatocellular carcinoma
• Liver function
• Nucleotide/nucleoside analogues
• Transarterial chemoembolization

• Adrenal Cortex Hormones/administration & dosage
• Adrenal Cortex Hormones/adverse effects
• Antineoplastic Agents/administration & dosage
• Antineoplastic Agents/adverse effects
• Antiviral Agents/therapeutic use
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• DNA, Viral/blood
• Doxorubicin/administration & dosage
• Doxorubicin/adverse effects
• Epirubicin/administration & dosage
• Epirubicin/adverse effects
• Hepatitis B Surface Antigens/blood
• Hepatitis B virus/genetics
• Hepatitis B, Chronic/blood
• Hepatitis B, Chronic/etiology
• Hepatitis B, Chronic/prevention & control
• Humans
• Liver Neoplasms/therapy
• Rituximab/administration & dosage
• Rituximab/adverse effects
• Virus Activation

It remains unclear what the antiviral therapy affects disease-free survival (DFS) and overall survival (OS) of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) at different tumor stages and baseline HBV DNA levels. In this study, we analyzed the association of antiviral treatment with DFS and OS based on the stratification of baseline HBV DNA load in early-stage (stages I and II) HCC patients.

We included 445 patients with early-stage HBV-related HCC who underwent curative resection, and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification. The Kaplan–Meier and Cox regression analyses were performed to determine the association of clinical characteristics with survival.

The median follow-up period was 74 months. For all patients, cumulative OS rates in the antiviral group were significantly higher than those in the non-antiviral group (log-rank test, P = 0.023), whereas no significant differences in DFS rates were observed. High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients. In patients with baseline HBV DNA levels ≥2000 IU/mL, antiviral treatment was significantly associated with prolonged DFS and OS (log-rank test, P = 0.041 and 0.001, respectively). In patients with HBV DNA levels <2000 IU/mL or undetectable, antiviral treatment did not show a significant benefit in prolonging DFS and OS.

High baseline HBV DNA levels are associated with poor prognosis in the patients with early-stage HCC, and the antiviral treatment could generate survival benefits for the patients. Therefore, antiviral treatment should be given for these patients. However, the effect of antiviral treatment on the patients with low viral load remains unclear, and further investigation is warranted.

• Antiviral therapy
• Hepatitis B virus
• Hepatocellular carcinoma
• Prognosis
• Resection

Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.

A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS).

The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5–27.7) months in the antiviral group and 9.6 (95% CI, 7.8–13.7) months in the non-antiviral group (log-rank test, P = 0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P = 0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5–37.7] months, P = 0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P = 0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95% CI, 5.2–13.5] months versus 7.4 [95% CI, 5.9–9.3] months, P = 0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.

Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.

The outcome after curative resection for hepatocellular carcinoma (HCC) remains unsatisfactory due to the high recurrence rate after surgery. In patients with hepatitis B virus (HBV)-related HCC, which is the majority of patients with HCC in Asia, a high viral load is a strong risk factor for HCC recurrence. It is logical to believe that antiviral therapy may improve the post-operative outcome by promoting viral clearance and hepatocyte regeneration, as well as improving residual liver volume in HCC patients with hepatitis B. However, the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established. There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon. Interferon treatment reduces the overall incidence of HBV-related HCC in sustained responders. However, side effects may limit its long-term clinical application. Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases. They may also improve the outcome after curative resection for HBV-related HCC. There are increasing evidence to suggest that antiviral therapy could suppress HBV, decrease the perioperative reactivation of viral replication, reduce liver injury, preserve the liver function before and after operation, and may lower the risk of HCC recurrence. After all, antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus, resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.

• Antiviral therapy
• Hepatitis B infection
• Hepatocellular carcinoma
• Hepatectomy
• Liver resection
• Outcome

• Antiviral Agents/therapeutic use
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/virology
• DNA, Viral/analysis
• Hepatectomy
• Hepatitis B virus
• Hepatitis B, Chronic/complications
• Hepatitis B, Chronic/drug therapy
• Humans
• Liver/surgery
• Liver Neoplasms/therapy
• Liver Neoplasms/virology
• Neoplasm Recurrence, Local/surgery
• Treatment Outcome
• Viral Load
• Virus Activation/drug effects
• Virus Replication