Li Z, et al. - Researchers investigated the impact of preoperative antiviral treatment (AVT) on the incidences of microvascular invasion (MVI) and early tumor recurrence after hepatectomy for hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC). They found that a high preoperative HBV DNA level independently conferred risk for MVI. Reduced incidences of MVI and early tumor recurrence after partial hepatectomy were observed in relation to antiviral treatment administered > 90 days prior to surgery.

Methods

• Researchers reviewed data on a cohort of 2,362 patients (median [interquartile range] age 50.6 (43.1-57.3) years; 84.6% men) who had R0 resection for HBV-related HCC between January 2008 and April 2010 at the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
• These patients were followed-up postoperatively for a median (interquartile range) duration of 44.8 (22.8-59.3) months.
• From June 2016 to October 2017, the investigators performed data analysis.
• The interventions included preoperative AVT and partial hepatectomy.
• They calculated overall survival and time to recurrence after surgery, which were compared using the Kaplan-Meier method, log-rank test, and Cox regression analysis.
• They used logistic regression analysis to evaluate independent risk factors of MVI presence.

Results

• No AVT was administered preoperatively to 2,036 patients (86.2%), while 326 (13.8%) were treated with ongoing AVT > 90 days before surgery.
• An increased risk of MVI was observed in relation to a preoperative HBV DNA level of ≥ 2000 IU/mL vs a preoperative HBV DNA level of < 2000 IU/mL in the non-AVT group (odds ratio [OR], 1.399; 95% CI: 1.151-1.701).
• A lower incidence of MVI (38.7% [126/326] vs 48.6% [989/2036]; P=0.001) and reduced risk of MVI (OR, 0.758; 95% CI: 0.575-0.998) was observed in patients receiving AVT vs the non-AVT group.
• An independent protective factor of MVI was a complete response to AVT (OR, 0.690; 95% CI: 0.500-0.952).
• Accordingly, decreased 6-month, 1-year, and 2-year recurrences were observed in relation to preoperative AVT vs non-AVT (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P < 0.001); AVT was found to offer protection against early tumor recurrence (hazard ratio, 0.732; 95% CI: 0.605-0.886).
• In addition, multiple intrahepatic recurrences (49.1% [549/1119] vs 36.2% [54/149]; P=0.003) and recurrences involving multiple hepatic segments were more likely to be seen in patients in the non-AVT group vs patients receiving AVT.