Effects of Antiviral Therapy on the Recurrence of Hepatocellular Carcinoma After Curative Resection or Liver Transplantation

Abstract

ContextHepatocellular carcinoma (HCC) is a fatal disease. Chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is the major cause of HCC. High viral replication rate and related hepatic/systematic inflammation are the major risk factors in HCC recurrence after hepatectomy or liver transplantation.Evidence AcquisitionSome of the carcinogenesis-related HBV mutations are also associated with poor prognosis for HCC patients. Antiviral therapy is an option for improving HCC prognosis after surgery. In case of HBV-associated HCC, treatment with interferon and nucleos(t)ide analogues (NAs), especially interferon, is effective in improving the prognosis. However, long-term use of NAs increases the possibility of developing drug-resistant viral mutations such as the HBV rtA181T/sW172 mutation, which increases the risk of HCC recurrence.ResultsIn cases of HCV-associated HCC, standard interferon with or without ribavirin therapy is effective in improving the prognosis of HCV-associated HCC; however, some HCV mutations, such as the amino acid substitution M91L, are associated with treatment failure and a poor prognosis. Therapeutic efficacy needs to be confirmed using largescale, randomized, placebo-controlled clinical trials.ConclusionsSurveillance of viral mutations during antiviral treatment and a better understanding of the associations of HCC recurrence with viral load, inflammation-associated signaling, and environmental factors can aid the development of more effective strategies for the prevention of HCC recurrence after surgery.

The progress and prospects of routine prophylactic antiviral treatment in hepatitis B-related hepatocellular carcinoma

“…However, long-term high-dose postoperative treatments may also suppress the immune system, leading to a reactivation of HBV. A high viral replication rate and related hepatic inflammation are the major risk factors in HCC recurrence after liver transplantation [38]. The reinfection of HBV itself, rather than related cancer recurrence, may be the chief cause of the high mortality rate after liver transplantation [39].…”

Predictors of Developing Hepatocellular Carcinoma in Treated HCV-Carriers in Morocco according to University Hospital Experience

“…When cirrhosis is already present, the protective effect is less clear. For cirrhosis due to hepatitis C, some studies—especially in Japan—showed a protective role of interferon-alfa [7, 8]. Virological response, but also merely biochemical response, seems to be associated with a lower risk of development of HCC [7], but screening is indicated even after SVR.…”

Cancer Evo-Dev, a novel hypothesis derived from studies on hepatitis B virus-induced carcinogenesis

“…This indicates that HBV evolution in adjacent tissues continues until the patient dies. Antiviral therapy that can attenuate viral replication and subsequent hepatic inflammation notably promotes postoperative prognosis of HBV-HCC patients [50][51][52][53] , possibly because antiviral treatment can block HBV evolution in adjacent hepatic tissues and also likely in remaining HCC tissues.…”

“…The synergistic effect of those three cytokines can promote the transformation of normal hepatocytes into stem-like cells. Antiviral therapy can significantly reduce the risks of occurrence and postoperative recurrence by HCC via relieving hepatic inflammation [50][51][52][53]119] , possibly because termination of inflammation can destroy the fertile environment for cancer evolution.…”