Feasibility of combining adjuvant transarterial chemoembolization with nucleos(t)ide analog therapy for patients with HBV-associated hepatocellular carcinoma after hepatectomy

Abstract

Abstract. Hepatocellular carcinoma (HCC) is the third leading cause of cancer-associated mortalities, and its prevalence is expected to increase in future decades. Hepatitis B virus (HBV) infection is the leading cause of HCC. Although hepatectomy is the preferred curative treatment for HCC, tumor recurrence is common, which is the most frequent cause of mortality in patients with HCC. HCC recurrence may originate from the primary tumor or be associated with remnant liver tissue, and include high viral load and hepatic inflammatory activity. Adjuvant transarterial chemoembolization and postoperative nucleos(t)ide analogs therapy are the two corresponding therapies. Following systematic searching of the PubMed database, the indications for adjuvant transarterial chemoembolization and nucleos(t)ide analog therapies for HBV-related HCC after hepatectomy were acquired. Additionally, the feasibility of combining these two therapies were also reviewed.

Role of Hepatectomy for Hepatocellular Carcinoma in the Era of Transplantation and Locoregional Therapy

“…74,88 In addition, subgroups that may derive benefit following adjuvant TACE may include patients with vascular invasion, multifocal intrahepatic disease, absent tumor capsule, poor tumor differentiation, and surgical margins less than 1 cm on final pathology. 89,90 Despite the intuitive belief and data from single centers that suggest that high-risk groups may benefit from adjuvant locoregional therapy, several systematic reviews have concluded that use of adjuvant TAC or TACE for patients is not supported by currently available data. 64,91,92 There has also been interest in systemic agents as adjuvant treatment, including oral chemotherapeutics, interferon, immunotherapy, vaccines, vitamin analogues, sorafenib, and heparanase inhibitor PO-88.…”

Adefovir dipivoxil is less expensive than lamivudine and associated with similar prognosis in patients with hepatitis B virus-related hepatocellular carcinoma after radical resection

“…Hepatic resection is widely recognized as a first-line treatment for patients with HCC 2,3. Nevertheless, the prognosis for patients after radical resection is discouraging, even when the disease is caught in an early stage: disease recurrence occurs in >70% of patients within 5 years after resection 4,5…”