Association of Preoperative Antiviral Treatment With Incidences of Microvascular Invasion and Early Tumor Recurrence in Hepatitis B Virus-Related Hepatocellular Carcinoma
| Autor: | Yong Xia, Tian Yang, Meng-Chao Wu, Zheng Li, Timothy M. Pawlik, Weiping Zhou, Zhengqing Lei, Han Zhang, Kui Wang, Jun Li, Xuying Wan, Feng Shen, Wan Y. Lau |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Hepatitis B virus Carcinoma Hepatocellular medicine.disease_cause Preoperative care Gastroenterology Antiviral Agents 03 medical and health sciences 0302 clinical medicine Hepatitis B Chronic Interquartile range Risk Factors Internal medicine Preoperative Care Carcinoma Medicine Hepatectomy Humans Neoplasm Invasiveness Risk factor Original Investigation business.industry Incidence Liver Neoplasms Odds ratio Hepatitis B Middle Aged medicine.disease Vascular Neoplasms 030220 oncology & carcinogenesis Hepatocellular carcinoma DNA Viral Microvessels 030211 gastroenterology & hepatology Surgery Female Neoplasm Recurrence Local business |
| Zdroj: | JAMA surgery. 153(10) |
| ISSN: | 2168-6262 |
| Popis: | IMPORTANCE: A reduced incidence of microvascular invasion (MVI) in hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) may be associated with a decreased risk of early tumor recurrence and better survival after partial hepatectomy. OBJECTIVE: To examine the association of preoperative antiviral treatment (AVT) with the incidences of MVI and posthepatectomy early tumor recurrence in HBV-related HCC. DESIGN, SETTING, AND PARTICIPANTS: Data on a cohort of 2362 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, were reviewed. The median (interquartile range) postoperative follow-up was 44.8 (22.8-59.3) months. Data were analyzed from June 2016 to October 2017. INTERVENTIONS: Preoperative AVT and partial hepatectomy. MAIN OUTCOMES AND MEASURES: Overall survival and time to recurrence after surgery were calculated and compared using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Independent risk factors of MVI presence were assessed by logistic regression analysis. RESULTS: Among 2362 included patients, 1999 (84.6%) were men, and the median (interquartile range) age was 50.6 (43.1-57.3) years. A total of 2036 patients (86.2%) did not receive any preoperative AVT, while 326 (13.8%) received ongoing AVT more than 90 days before surgery. In the non-AVT group, 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 associated with an increased risk of MVI (odds ratio [OR], 1.399; 95% CI, 1.151-1.701). Compared with the non-AVT group, patients receiving AVT had 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). A complete response to AVT was an independent protective factor of MVI (OR, 0.690; 95% CI, 0.500-0.952). Accordingly, preoperative AVT was associated with decreased 6-month, 1-year, and 2-year recurrences vs non-AVT (14.2%, 24.6%, and 38.5%, respectively, vs 23.4%, 37.1%, and 52.3%; P |
| Databáze: | OpenAIRE |
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