Clinical

HBV reduces recurrence-free survival after surgery for hepatocellular carcinoma

Last Updated: 2009-11-04 16:23:48 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - In cirrhotic patients, hepatitis B virus (HBV) infection is associated with a poorer long-term prognosis after hepatectomy for hepatocellular carcinoma, according to Italian researchers.

Infection with HBV, lead investigator Dr. Matteo Cescon told Reuters Health, "is a strong predictive factor for tumor recurrence after liver resection for hepatocellular carcinoma in patients with cirrhosis."

In the October issue of the Archives of Surgery, Dr. Cesco of the University of Bologna and colleagues report that they came to this conclusion after analyzing data on 240 cirrhotic patients who underwent hepatectomy. All had hepatocellular carcinoma with single nodules no greater than 5 cm in diameter.

At 5 years, recurrence-free survival was 38% in patients who were HBV-negative and hepatitis C virus (HCV)-positive at the time of resection. Recurrence-free survival was similar - 34% -- in patients without HBV or HCV infection at operation. Among HBV-positive, HCV-negative patients, only 9% were recurrence-free at 5 years.

Factors independently associated with recurrence-free survival were HBV infection (OR, 1.79) and poor tumor differentiation (OR, 2.01).

Recurrence-free survival at 5 years in those with neither factor was 49%. For patients with one factor, it was 20% and for those with both, it was 8%.

The findings, Dr. Cescon continued, add more support for use of adjuvant antiviral treatment.

"Given the high risk of recurrence after resection in patients who are seropositive for hepatitis B virus and have poorly differentiated cancers," he concluded, "this population should be considered as a major candidate for a policy of salvage liver transplantation."

Dr. David M. Levi of the University of Miami, co-author of an accompanying editorial, remarked to Reuters Health that "through a simple but thorough analysis, the authors have demonstrated that for patients with cirrhosis and hepatocellular carcinoma, a diagnosis of HBV infection negatively affects disease-free survival."

Arch Surg 2009;144:906-913.