A Comparative Study of Antiviral Therapy After Resection of Hepatocellular Carcinoma in the Immune-Active Phase of Hepatitis B Virus Infection

Background The role of antiviral therapy for patients in the immune-active phase of hepatitis B virus (HBV) infection who underwent partial hepatectomy for hepatocellular carcinoma (HCC) is unknown. Methods From January 2004 to June 2007, a nonrandomized comparative study for postoperative antiviral treatment was conducted on patients who underwent curative hepatectomy for advanced HCC. Patients in the treatment group ( n = 43) received lamivudine with or without adefovir dipivoxil, while the control group ( n = 36) received no antiviral treatment. Results The treatment group had a significantly higher HBeAg seroconversion rate (57.2% vs. 5.6%) and a higher HBV DNA suppression rate (87.2% vs. 2.8%) after 12 months of antiviral treatment. The treatment group also had a significantly greater increase in residual liver volume per unit surface area following hepatectomy (78.0 ± 40.1 cm 3 /m 2 vs. 35.8 ± 56.0 cm 3 /m 2 ) at 6-month postoperation. After a median follow-up of 12 months, there was no significant difference in recurrence rate after surgery between the treatment group and the control group (76.7% and 91.7%). There was a significant difference in the overall survival rate but not in the disease-free survival rate. The 1- and 2-year overall survival rates were 41.9% and 7.0%, respectively, for the treatment group, and 33.3% and 0%, respectively, for the control group. The 1- and 2-year disease-free survival rates were 23.3% and 2.3%, respectively, for the treatment group, and 8.3% and 0%, respectively, for the control group. Conclusion Although nucleoside analogs did not reduce short-term recurrence rate, they promoted postoperative viral clearance and increased residual liver volume, which significantly enhanced tolerance to subsequent therapy for disease recurrence.