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J Viral Hepat. 2019 Nov 21. doi: 10.1111/jvh.13236. [Epub ahead of print]
Peg-interferon and nucleos(t)ide analogue combination at inception of antiviral therapy improves both anti-HBV efficacy and long-term survival among HBV DNA positive hepatocellular carcinoma patients after hepatectomy/ablation.
Qi W1, Zhang Q1, Xu Y1, Wang X1, Yu F1, Zhang Y1, Zhao P1, Guo H1, Zhou C1, Wang Z1, Sun Y2, Liu L2, Xuan W3, Wang J1.
Author information
1
Digestive Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
2
Invasive Technology Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
3
Hepatobiliary surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Abstract
Antiviral therapy has been shown to improve the prognosis of hepatitis B virus (HBV) DNA-positive hepatocellular carcinoma (HCC) after radical treatment, but antiviral treatments require further optimization. This study aimed to evaluate the efficacies of different antiviral strategies with HCC patients after hepatectomy/ablation. This prospective, randomized, controlled, and multi-center trial enrolled HBV DNA-positive primary HCC patients after hepatectomy/ablation between January 2007 and January 2009. Patients were divided into four groups: early-combination (entecavir plus Peg-interferon [IFN]α-2a co-administration during year 1); late-combination (addition of Peg-IFNα-2a for 48 weeks after 1 year of entecavir); nucleos(t)ide analogue[NA] monotherapy; and non-antiviral treatment. Primary endpoints included recurrence-free survival and overall survival. A total of 447 patients were enrolled. The 2-year and 8-year recurrence free survival and 8-year overall survival rates were significantly higher in the early-combination group than in the other two antiviral groups (P<0.05). After 48 weeks treatment, more patients achieved an HBsAg reduction >1500 IU/ml and the mean HBsAg level was significantly lower in the early-combination group compared with the late-combination and NA monotherapy groups (P<0.05). Multivariate analysis showed that early-combination therapy and a reduction in HBsAg by >1500 IU/mL after 48 weeks of therapy correlated with reduced mortality and disease recurrence. Early introduction of combination antiviral treatment may represent a more effective therapeutic strategy for patients with HBV DNA-positive HCC after hepatectomy/ablation. A reduction in HBsAg by >1500 IU/mL after 48 weeks treatment is associated with reduced mortality and disease recurrence of HBV DNA-positive HCC patients after hepatectomy/ablation.
© 2019 John Wiley & Sons Ltd.
KEYWORDS:
(MeSH)s interferon; Drug Combinations; hepatitis B virus; hepatocellular carcinoma; prognosis
PMID:
31755220
DOI:
10.1111/jvh.13236
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