Antiviral therapy improves survival in patients with HBV infection and intrahepatic cholangiocarcinoma undergoing liver resection.

The impact of hepatitis B virus (HBV) infection on outcomes after resection of intrahepatic cholangiocarcinoma (ICC) has not been reported. The aim of this study was to examine the impact of antiviral therapy on survival outcomes after liver resection for patients with ICC and underlying HBV infection. Data on 928 patients with ICC and HBV infection who underwent liver resection at two medical centers between 2006 and 2011 were analyzed. Data on viral reactivation, tumor recurrence, cancer-specific survival (CSS) and overall survival (OS) were obtained. Survival rates were analyzed using the time-dependent Cox regression model adjusted for potential covariates. Postoperative viral reactivation occurred in 3.3%, 8.3% and 15.7% of patients who received preoperative antiviral therapy, who did not receive preoperative antiviral therapy with a low, or a high HBV-DNA level (< or ≥2,000 IU/ml), respectively (p <0.001). A high viral level and viral reactivation were independent risk factors of recurrence (hazard ratio [HR] 1.22 and 1.34), CSS (HR 1.36 and 1.46) and OS (HR1.23 and 1.36). Five-year recurrence, CSS and OS were better in patients who received antiviral therapy (70.5%, 46.9% and 43.0%) compared with patients who did not receive antiviral therapy and had a high viral level (86.5%, 20.9% and 20.5%, all p <0.001), respectively. The differences in recurrence, CSS and OS were minimal compared with no-antiviral therapy patients with a low viral level (71.7%, 35.5% and 33.5%, p = 0.057, 0.051 and 0.060, respectively). Compared to patients with a high viral level who received no antiviral therapy, patients who initiated antiviral therapy either before or after surgery had better long-term outcomes (HR 0.44 and 0.54 for recurrence; 0.38 and 0.57 for CSS; 0.46 and 0.54 for OS, respectively). Viral reactivation was associated with worse prognoses after liver resection for HBV-infected patients with ICC. Antiviral therapy decreased viral reactivation and prolonged long-term survival for patients with ICC and a high viral level. Postoperative hepatitis B virus reactivation was associated with an increased complication rate and a decreased survival rate after liver resection in patients with ICC and hepatitis B virus infection. Antiviral therapy before liver resection reduced the risk of postoperative viral reactivation. Both pre- and postoperative antiviral therapy was effective in prolonging patient survival.

Lei Z ，Xia Y ，Si A ，Wang K ，Li J ，Yan Z ，Yang T ，Wu D ，Wan X ，Zhou W ，Liu J ，Wang H ，Cong W ，Wu M ，Pawlik TM ，Lau WY ，Shen F ... -  《-》

Prognostic impact of hepatitis B virus infection in patients with intrahepatic cholangiocarcinoma.

Hepatitis B virus (HBV)-associated intrahepatic cholangiocarcinoma (ICC) was reported to have a favourable prognosis. We investigated the clinicopathological features of patients with HBV-associated ICC and compared post-resection survival outcomes of ICC patients with and without hepatitis B surface antigen (HBsAg) to assess the prognostic impact of HBV infection. A single-institution cohort of 292 patients who underwent macroscopic curative resection for ICC were divided into HBV (n = 37) and non-HBV (n = 255) groups. Their medical records were reviewed retrospectively. In comparison with the clinicopathological features, patient age, proportion of anatomical resection, perineural invasion and lymph node (LN) metastasis were different between the two groups. Antiviral therapy was administered to 15 (40.5%) and 27 (73.0%) patients before and after surgery, respectively. Univariate analyses revealed that risk factors were tumour size >5 cm, anatomical resection, perineural invasion, lymphovascular invasion and LN metastasis for tumour recurrence and HBV infection, tumour size >5 cm, anatomical resection, perineural invasion, lymphovascular invasion and LN metastasis for patient survival. Multivariate analysis revealed that independent risk factors were tumour size >5 cm, perineural invasion and LN metastasis for both tumour recurrence and patient survival. HBV infection showed statistically marginal significances only in univariate analysis, thus not being an independent risk factor. We observed that ICC patients with HBV infection often showed favourable tumour features probably due to early diagnosis, but their post-resection outcomes were not significantly different from those of patients without HBV infection. Therefore, the same treatment and surveillance policies should be applied regardless of HBV serology.

Ahn CS ，Hwang S ，Lee YJ ，Kim KH ，Moon DB ，Ha TY ，Song GW ，Lee SG ... -  《-》

Prognosis of Intrahepatic Cholangiocarcinomas with HBV Infection is Better than Those with Hepatolithiasis After R0 Liver Resection: A Propensity Score Matching Analysis.

Wang Q ，Li J ，Lei Z ，Wu D ，Si A ，Wang K ，Wang Y ，Wan X ，Lau WY ，Shen F ... -  《-》

Prognosis after resection for hepatitis B virus-associated intrahepatic cholangiocarcinoma.

Wu ZF ，Wu XY ，Zhu N ，Xu Z ，Li WS ，Zhang HB ，Yang N ，Yao XQ ，Liu FK ，Yang GS ... -  《-》

Antiviral Therapy Inhibits Viral Reactivation and Improves Survival after Repeat Hepatectomy for Hepatitis B Virus-Related Recurrent Hepatocellular Carcinoma.

The aim of this study was to explore the impact of antiviral therapy (AVT) on short- and long-term outcomes after rehepatectomy for patients with recurrent hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). We analyzed data from 583 consecutive patients who underwent rehepatectomy for intrahepatic recurrence of HBV-related HCC after initial hepatectomy, between 2006 and 2011 at the Eastern Hepatobiliary Surgery Hospital. Tumor re-recurrence, recurrence to death survival (RTDS), and overall survival (OS) were compared using the Kaplan-Meier method and log-rank test. The independent risk factors of prognoses were analyzed using the Cox proportional hazards model. Postoperative viral reactivation, surgical morbidity, and mortality were also observed. Preoperative AVT reduced viral reactivation rate after rehepatectomy (5.8% for AVT patients, 16.3% and 16.6% for non-AVT patients with viral level ≤ or >2,000 IU/mL, respectively; p ≤ 0.028). Viral reactivation and non-AVT were independent risk factors of tumor re-recurrence (hazard ratios 1.446 and 1.778, respectively), RTDS (1.691 and 2.457, respectively), and OS (1.781 and 1.857, respectively). The AVT improved long-term outcomes as compared with non-AVT with a viral level of ≤ or >2,000 IU/mL (5-year re-recurrence rate: 69% vs 81% vs 96%, respectively; 5-year RTDS rate: 47% vs 27% vs 17%, respectively; all p ≤ 0.016). Pre- plus postoperative AVT achieved a better 5-year OS rate than postoperative AVT alone (83% vs 60%; p = 0.045); there were insignificant differences in 5-year re-recurrence and RTDS rates (61% vs 77%, p = 0.102; 50% vs 44%, p = 0.395). Preoperative AVT decreased viral reactivation rate, and AVT initiated either before or after rehepatectomy contributed to better long-term prognoses after rehepatectomy for recurrent HBV-related HCC.

Huang S ，Xia Y ，Lei Z ，Zou Q ，Li J ，Yang T ，Wang K ，Yan Z ，Wan X ，Shen F ... -  《-》