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World J Gastroenterol. May 28, 2014; 20(20): 6006-6012
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6006
Impact of antiviral therapy on post-hepatectomy outcome for hepatitis B-related hepatocellular carcinoma
Charing Ching Ning Chong, Grace Lai Hung Wong, Paul Bo San Lai
Charing Ching Ning Chong, Paul Bo San Lai, Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
Grace Lai Hung Wong, Institute of Digestive Disease and Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
Author contributions: Chong CCN, Wong GLH and Lai PBS contributed equally to this work; Chong CCN contributed to the acquisition, analysis and interpretation of data, and drafting the article; Wong GLH contributed to the drafting and revising the article; Lai PBS contributed to the conception and design, and revising it critically for important intellectual content.
Correspondence to: Charing Ching Ning Chong, MBChB, MSc, FCSHK, Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. chongcn@surgery.cuhk.edu.hk
Telephone: +852-2-6321496 Fax: +852-2-6377974
Received: November 7, 2013
Revised: February 2, 2014
Accepted: March 18, 2014
Published online: May 28, 2014
Abstract

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.

Keywords: Antiviral therapy, Hepatitis B infection, Hepatocellular carcinoma, Hepatectomy, Liver resection, Outcome

Core tip: The impact of antiviral therapy on clinical outcomes after curative liver resection in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains to be established. There are increasing evidence to suggest that antiviral therapy could suppress HBV replication, decrease the perioperative reactivation of virus, reduce liver injury, preserve the liver function before and after operation, and may lower the risk of HCC recurrence. Antiviral therapy may also improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus, rendering in a higher chance of receiving aggressive salvage therapy during HCC recurrence. We herein review the currently available evidences on this issue.