專題討論13:肝癌治療新進展

程 序 表

S13-1
The role of antiviral therapy after curative treatment of HCC
吳俊穎Professor Chun-Ying Wu
Taichung Veterans General Hospital

  Tumor recurrence is a major issue for patients with hepatocellular carcinoma (HCC) after curative treatment, including liver resection and radiofrequency ablation (RFA). Many factors affect HCC recurrence risk after curative treatment, including tumor size and stage, serum α-fetoprotein level, cirrhosis, hepatitis B e antigen status, and hepatitis B virus (HBV) load. Among these factors, HBV viral load is the most clinically controllable.
  Higher HBV viral load has been reported to be an independent factor for HCC recurrence in patients with HBV-related HCC. Antiviral therapy is effective in suppressing HBV replication and in ameliorating HBV-related liver diseases. In our previous nationwide cohort study, we found antiviral therapy use was associated with a lower risk of HCC recurrence among patients with HBV-related HCC after liver resection. Patients with antiviral therapy had lower 6-year HCC recurrence risk compared with those without antiviral therapy (45.6% vs. 54.6%). The adjusted hazard ratio (HR) was 0.67. This secondary chemopreventive effect of antiviral therapy has been confirmed by other randomized clinical trials. In a recent nationwide cohort study, we found antiviral therapy is also effective in reducing HCC recurrence among patients with HBV-related HCC after RFA. The 2-year HCC recurrence rate of the antiviral therapy group was significantly lower than that of the untreated group (41.8% vs. 54.3%). The adjusted HR was 0.69.
  In conclusion, antiviral therapy for hepatitis B is associated with a reduced risk of HCC recurrence in HBV-related HCC patients after curative therapy. Further studies will be helpful to investigate the magnitude of this beneficial effect and to examine whether antiviral therapy should be used in all or only a subset of these HCC patients.