Li Z, et al. - 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 for MVI was high preoperative HBV DNA level. Following partial hepatectomy for HBV-related HCC, reduced incidences of MVI and early tumor recurrence were reported in relation to antiviral treatment administered more than 90 days before surgery.

Methods

• Researchers reviewed data on a cohort of 2,362 patients who underwent 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 analysis was performed.
• 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.
• They used logistic regression analysis to assess independent risk factors of MVI presence.

Results

• This study included a total of 2,362 patients, of whom 1,999 (84.6%) were men, and the median (interquartile range) age was 50.6 (43.1-57.3) years.
• Preoperative AVT was not received by a total of 2,036 patients (86.2%), whereas 326 (13.8%) received ongoing AVT more than 90 days before surgery.
• They observed that a preoperative HBV DNA level of 2,000 IU/mL or greater in the non-AVT group was related to an increased risk of MVI (odds ratio [OR], 1.399; 95% CI, 1.151-1.701) vs a preoperative HBV DNA level of less than 2000 IU/mL.
• They also reported that in comparison to the non-AVT group, patients receiving AVT exhibited 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).
• Findings showed a complete response to AVT to be an independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952).
• 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).
• In addition, patients in the non-AVT group vs those receiving AVT 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.