Antiviral Therapy Can Prevent Liver Cancer Recurrence CUHK Represents HK to Draw Up Asian Pacific Treatment Guideline for Chronic Hepatitis B
Hepatocellular carcinoma (HCC) is one of the top cancer killers in Hong Kong. In 2009, it ranked fourth in cancer incidence (1,832 cases) and third in cancer mortality (1,488 cases). In Hong Kong, over 80% of HCC is caused by hepatitis B virus infection. In all current clinical practice guidelines, antiviral treatment is recommended for patients who suffer liver cirrhosis or active hepatitis. Although surgical resection and loco-regional therapy can be applied to small HCC, about 70% of the patients suffer HCC recurrence within five years after the surgical resection. It is still unclear whether antiviral therapy can prevent HCC recurrence. The Center for Liver Health at The Chinese University of Hong Kong (CUHK) has conducted a meta-analysis to sum up the evidence in the literature on the role of antiviral therapy to prevent HCC recurrence after surgical resection and loco-regional therapy, and is representing Hong Kong in drawing up the latest guideline for chronic hepatitis B management.
High level of hepatitis B virus replication, as reflected by high HBV DNA level, is one of the key factors leading to the development of HCC. Among patients who undergo surgical resection of HCC, those who have higher HBV DNA level tend to have a higher risk of HCC recurrence. There were many studies conducted in the past few years trying to find out whether antiviral therapy can prevent HCC recurrence, but the sample sizes were usually small and failed to provide accurate data analysis.
Up to March 2010, The Center for Liver Health at CUHK studied nine literature reporting HCC recurrence in chronic hepatitis B patients. 551 patients were studied, of which 204 had antiviral treatment and 347 were untreated controls. The analysis reveals that antiviral treatment was associated with over 40% risk reduction for HCC recurrence as compared with the untreated controls. Furthermore, antiviral treatment was associated with more than 85% reduction in risk of liver failure and more than 70% risk reduction in death after HCC treatment.
Based on the strong evidence of this analysis, CUHK is representing Hong Kong in drawing up the chronic hepatitis B management consensus guideline of the Asian Pacific Association for the Study of the Liver. The guideline recommends chronic hepatitis B patients who have HCC resected or treated by loco-regional therapy to receive antiviral therapy if they have high level of HBV DNA (>2000 IU/ml).