The effects of pre-surgical antiviral therapy among patients with hepatitis B-related hepatocellular carcinoma: A meta-analysis

Abstract

Significance:
Liver cancer is the second most common cause of cancerrelated deaths worldwide. Current guidelines recommend surgical resection for non-cirrhotic hepatitis B-related hepatocellular carcinoma (HCC) patients, with studies supporting the use of antiviral therapy post-surgery prior to anticancer treatment and immunosuppressive therapy. Data on pre-surgical antiviral therapy however, is less clear-cut. This study investigates the overall survival, disease-free survival and viral reactivation of early antiviral treatment prior to hepatectomy. Included studies were those hepatitis B-related HCC patients at least 18 years old with curative resection as primary form of treatment, comparing with and without pre-surgical antiviral therapy, and with data on viral recurrence or survival. Excluded were those positive for other viral hepatitis or HIV co-infection, and with HCC therapy other than hepatectomy.

Results:
Four studies selected had a pooled sample of 833 – 417 in the antiviral arm and 416 in the control arm. Patients given nucleoside analogues prior to liver resection have significantly reduced risk of viral reactivation compared to control subjects with relative risk of 0.12 (95% CI, 0.04-0.36). For the 1-, 3- and 5-year diseasefree survival, treatment with nucleoside analogues prior to surgery shows a trend towards increased survival rate with risk ratios of 1.23, 1.18 and 1.13, respectively. There is significant increase in overall survival among those given nucleoside analogues prior to hepatectomy with risk ratios at 1.11, 1.26 and 1.17, respectively.

Conclusion:
For chronic hepatitis B-related HCC patients, giving nucleoside analogues prior to liver resection significantly decreases viral reactivation and improves disease-free and overall survival.