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World J Hepatol. Sep 27, 2014; 6(9): 652-659
Published online Sep 27, 2014. doi: 10.4254/wjh.v6.i9.652
Nucleos(t)ide analogues to treat hepatitis B virus-related hepatocellular carcinoma after radical resection
Yang Ke, Lin Wang, Le-Qun Li, Jian-Hong Zhong
Yang Ke, Le-Qun Li, Jian-Hong Zhong, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Yang Ke, Lin Wang, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
Author contributions: All authors contributed equally to the design of the review; Ke Y and Zhong JH wrote the review and developed figures; all authors contributed to critical revision and editing of the article.
Correspondence to: Jian-Hong Zhong, MD, PhD, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, He Di Rd. #71, Nanning 530021, Guangxi Zhuang Autonomous Region, China. zhongjianhong66@163.com
Telephone: +86-771-5330855 Fax: +86-771-5312000
Received: June 29, 2014
Revised: August 4, 2014
Accepted: September 4, 2014
Published online: September 27, 2014
Abstract

Significant advances have been made in nucleos(t)ide analogue (NA) therapy to treat chronic hepatitis B, and this therapy reduces the risk of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in some patients. However, whether NAs can also prevent recurrence after radical resection of HBV-related HCC remains controversial and is an important question, given that most patients will experience recurrence within a few years of curative surgery. Here we systematically reviewed the literature since 2004 on outcomes after administering NAs to patients with HBV-related HCC following radical resection. We focused on treatment indications, duration, effects on recurrence-free survival and overall survival, and the management of NA resistance. We find that patients with HCC should strongly consider NA therapy if they are positive for HBV-DNA, and that the available evidence suggests that postoperative NA therapy can increase both recurrence-free and overall survival. To minimize drug resistance, clinicians should opt for potent analogues with higher resistance barriers, and they should monitor the patient carefully for emergence of NA-resistant HBV.

Keywords: Antiviral therapy, Hepatitis B virus, Hepatocellular carcinoma, Liver resection, Nucleos(t)ide analogue, Survival rate

Core tip: Significant advances have been made in nucleos(t)ide analogue (NA) therapy to treat chronic hepatitis B. However, for patients undergoing radical resection for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), a number of important questions remain undefined, including when NA therapy should be initiated, how long the treatment should continue, and whether NAs can prevent recurrence after radical resection. Here we review the available evidence on these questions in the Medline database. We focus on NA treatment indications, duration, effects on recurrence-free survival and overall survival, and management of NA resistance in patients with HBV-related HCC.