Postoperative hepatitis B virus reactivation and surgery‐induced immunosuppression in patients with hepatitis B‐related hepatocellular carcinoma

Xie, Zhibo; Zhu, Shao‐Liang; Peng, Yuchong; Chen, Jie; Wang, Xiaobo; Ma, Liang; Bai, Tao; Xiang, Bang‐De; Li, Le‐Qun; Zhong, Jian‐Hong

doi:10.1002/jso.24044

Cited by 14 publications

(26 citation statements)

References 49 publications

(53 reference statements)

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“…Hepatectomy may induce immunosuppression and thereby lead to HBV replication [24–26]. Subsequent recovery of immune function results in rapid destruction of infected hepatocytes, causing postoperative hepatitis and acute hepatic failure.…”

Section: Discussionmentioning

confidence: 99%

Effects of antiviral therapy on post-hepatectomy HBV reactivation and liver function in HBV DNA-negative patients with HBV-related hepatocellular carcinoma

Gong

Zhong

et al. 2017

Oncotarget

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The ability of antiviral therapy to reduce risk of post-hepatectomy hepatitis B virus (HBV) reactivation in patients negative for viral DNA is unclear. This prospective study involved 174 consecutive patients with hepatitis B virus related hepatocellular carcinoma who were negative for hepatitis B virus DNA in serum and who underwent hepatic resection. Hepatitis B virus reactivation occurred in 30 patients in the non-antiviral group (27.8%) but in only 2 patients in the antiviral group (3.0%, P < 0.001). Based on multivariate analysis, risk of hepatitis B virus reactivation was associated with minor hepatectomy and absence of antiviral therapy. Liver function indicators at one week after resection did not differ significantly between the two groups, or between patients who experienced hepatitis B virus reactivation or not. Nevertheless, alanine aminotransferase and albumin at 1 month after resection were significantly higher in the antiviral group than in the non-antiviral group, and they were significantly higher in patients who did not experience hepatitis B virus reactivation than in those who did. Therefore, patients with hepatitis B virus related hepatocellular carcinoma face substantial risk of hepatitis B virus reactivation after hepatectomy, even if they are negative for viral DNA at baseline. Antiviral therapy can reduce the risk of reactivation, helping improve liver function after surgery. (Clinicaltrials.gov registration number: NCT02829359).

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Section: Discussionmentioning

confidence: 99%

Effects of antiviral therapy on post-hepatectomy HBV reactivation and liver function in HBV DNA-negative patients with HBV-related hepatocellular carcinoma

Gong

Zhong

et al. 2017

Oncotarget

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“…Numerous studies indicate that nucleos(t)ide analogues therapy not only suppresses HBV replication and protects liver function6,12,19,22–26 but also increases overall and recurrence-free survival in patients with HBV-related HCC 6–8,13,27–31. While this body of evidence has helped drive the widespread use of nucleos(t)ide analogues in HBV-related HCC patients, it does not help clinicians decide between alternative analogues when particular drugs are contraindicated or when the cost of a drug becomes prohibitive.…”

Section: Discussionmentioning

confidence: 99%

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

Zhong

Yang

Zhu

et al. 2016

OTT

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AimLamivudine (LAM) and adefovir dipivoxil (ADV) are widely used in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), but few studies have directly compared their therapeutic efficacy and treatment cost. This study aims to compare LAM with ADV head-to-head in these patients.MethodsWe retrospectively analyzed 201 patients with HBV-related HCC who underwent radical resection and subsequently received LAM (n=155) or ADV (n=46). The two groups were compared in terms of HBV-DNA levels, liver function, antiviral resistance, recurrence-free, and overall survival, as well as antiviral medication costs.ResultsDespite significant improvement in HBV-DNA and alanine aminotransferase level in the LAM group after 1 year of antiviral therapy, these parameters did not differ significantly between the two groups over the following 2 years. Incidence of antiviral resistance after 1, 2, and 3 years of antiviral treatment was significantly higher in the LAM group (19.5%, 45.7%, and 56.4%) than in the ADV group (0%, 3.3%, and 14.5%; P<0.001). Overall survival at 1, 2, and 3 years after resection was similar for the LAM group (84.5%, 69.3%, and 64.6%) and the ADV group (84.1%, 77.8%, and 63.4%; P=0.905). Recurrence-free survival at the three follow-up points was also similar for the LAM group (71.7%, 58.3%, and 43.9%) and the ADV group (81.1%, 66.1%, and 53.0%; P=0.452). Cox regression analysis confirmed that both nucleos(t)ide analogues were associated with similar overall and recurrence-free survival. However, the average medication costs after 1, 2, and 3 years of antiviral treatment were significantly higher in the LAM group (€3.0, €4.8, and €5.6 per person per day) than in the ADV group (€2.2, €2.4, and €3.1 per person per day; all P<0.05).ConclusionADV and LAM are associated with similar survival benefit in patients with HBV-related HCC after radical resection, but ADV is more cost-effective.

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“…This drastically increases both the trauma caused by the surgical procedure and the risk of post-surgical liver failure in cirrhosis. 13,14 It is generally acknowledged that the effects of RFA treatment on small HCC lesions are comparable to those of surgical resection, and in such cases, RFA can be used as a first-line treatment. 1,5,15 RFA can produce satisfactory effects and preserve liver tissues for patients with small lesions located deep in the liver.…”

Section: Introductionmentioning

confidence: 99%

<p>Long-Term Survival in Patients Receiving Combination Therapy with Resection and Radiofrequency Ablation for Multi-Focal Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B: A Retrospective Controlled Study</p>

Yan¹,

Man²,

Lü³

et al. 2020

CMAR

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To evaluate the survival outcomes of combined liver resection (LR) and radiofrequency ablation (RFA) on multi-focal hepatocellular carcinoma (HCC) in patients with Barcelona clinic liver cancer (BCLC) stage B. Methods: A total of 210 cases of HCC were included in this study. In 42 cases, patients were treated with combination therapy using LR and RFA (LRCRFA). In 84 cases, patients underwent transarterial chemoembolization (TACE), and in another 84 cases, patients underwent LR; both the TACE and LR groups served as controls. It both categorized as BCLC stage B for LRCRFA and TACE groups but as BCLC stage A for LR group. Results: The overall survival (OS) rate of the LRCRFA group was significantly higher than that of the TACE group (P<0.001) but was not significantly different when compared with the LR group (P=0.544). The disease-free survival (DFS) rate of the LRCRFA group was significantly lower than that of the LR group (P=0.029). Patients with ≤4 tumors or those with ≤5 tumors no larger than 6 cm in diameter experienced better long-term outcomes than other patients in the same LRCRFA group. The OS rates and DFS rates were not significantly different from those of patients in the LR group (P>0.05). Having more than 2 existing tumors was an independent risk factor for OS rate. Conclusion: Combination therapy using LR and RFA can more effectively improve the prognosis of these patients than TACE. Patients with BCLC stage B HCC with ≤4 tumors or ≤5 tumors smaller than 6 cm in diameter are the ideal candidates for the application of LRCRFA.

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Postoperative hepatitis B virus reactivation and surgery‐induced immunosuppression in patients with hepatitis B‐related hepatocellular carcinoma

Abstract: PHR may be associated with resection-induced immunosuppression in patients with HBV-related HCC.

Cited by 14 publications

References 49 publications

Effects of antiviral therapy on post-hepatectomy HBV reactivation and liver function in HBV DNA-negative patients with HBV-related hepatocellular carcinoma

Effects of antiviral therapy on post-hepatectomy HBV reactivation and liver function in HBV DNA-negative patients with HBV-related hepatocellular carcinoma

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

<p>Long-Term Survival in Patients Receiving Combination Therapy with Resection and Radiofrequency Ablation for Multi-Focal Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B: A Retrospective Controlled Study</p>

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