Li Z, et al. - In this cohort study, researchers assessed how preoperative antiviral treatment (AVT) correlates with the incidences of microvascular invasion (MVI) and posthepatectomy early tumor recurrence in hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC). They found that an independent risk factor of MVI was high preoperative HBV DNA level. Findings suggested an association of antiviral treatment administered more than 90 days before surgery with reduced incidences of MVI and early tumor recurrence after partial hepatectomy for HBV-related HCC.

Methods

• Researchers reviewed data on a cohort of 2362 subjects 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.
• They performed postoperative follow-up for median (interquartile range) period of 44.8 (22.8-59.3) months.
• From June 2016 to October 2017, data were analyzed.
• Interventions included preoperative AVT and partial hepatectomy.
• They calculated and compared overall survival and time to recurrence after surgery using the Kaplan-Meier method, log-rank test, and Cox regression analysis.
• By logistic regression analysis, independent risk factors of MVI presence were evaluated.

Results

• This study included a total of 2362 patients, of whom 1999 (84.6%) were men, and the median (interquartile range) age was 50.6 (43.1-57.3) years.
• It was noted that 2036 patients (86.2%) did not receive any preoperative AVT, whereas 326 (13.8%) received ongoing AVT more than 90 days before surgery.
• Compared with a preoperative HBV DNA level of less than 2000 IU/mL, a preoperative HBV DNA level of 2000 IU/mL or greater was related to an increased risk of MVI (odds ratio [OR], 1.399; 95% CI, 1.151-1.701) in the non-AVT group.
• Patients receiving AVT showed a lower incidence of MVI (38.7% [126 of 326] vs 48.6% [989 of 2036]; P=.001) and reduced risk of MVI (OR, 0.758; 95% CI, 0.575-0.998) compared with the non-AVT group.
• An independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952) was a complete response to AVT.
• Preoperative AVT vs non-AVT was related to decreased 6-month, 1-year, and 2-year recurrences (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P < .001); AVT conferred protection against early tumor recurrence (hazard ratio, 0.732; 95% CI, 0.605-0.886).
• Compared with patients receiving AVT, those in the non-AVT group were more likely to have multiple intrahepatic recurrences (49.1% [549 of 1119] vs 36.2% [54 of 149]; P=.003) and recurrences involving multiple hepatic segments.