Effects of Antiviral Therapy on HBV Reactivation and Survival in Hepatocellular Carcinoma Patients Undergoing Hepatic Artery Infusion Chemotherapy

Shousheng Liu, Jinfa Lai, Ning Lyu, Qiankun Xie, Huijiao Cao, Dabiao Chen, Meng He, Bei Zhang, Ming Zhao, Shousheng Liu, Jinfa Lai, Ning Lyu, Qiankun Xie, Huijiao Cao, Dabiao Chen, Meng He, Bei Zhang, Ming Zhao

Abstract

Background: This study aimed to investigate the influence of hepatic artery infusion chemotherapy (HAIC) on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg) positive patients with primary hepatocellular carcinoma (HCC) as well as evaluate the role of antiviral prophylaxis in these patients.

Methods: We enrolled 170 HBsAg-positive advanced HCC patients receiving HAIC using mFOLFOX regimen, of which 137 patients received antiviral prophylaxis. Risk factors for HBV reactivation were analyzed. The overall survival (OS) from the first application of HAIC were compared between antiviral and non-antiviral groups.

Results: A total of 25 patients (14.7%) developed HBV reactivation after HAIC, of which 16 patients received antiviral treatment and nine patients did not. The incidence of HBV reactivation was 11.7% (16/137) in antiviral group and 27.3% (9/33) in non-antiviral group respectively. No antiviral prophylactic was the only significant risk factor for HBV reactivation (OR=12.35, 95% confidence interval (CI) 4.35-33.33, p<0.001). Patients in antiviral group received more cycles of HAIC compared with non-antiviral group (3.11 ± 1.69 vs 1.75 ± 1.18, p<0.05) at the time of HBV reactivated. Seven of the 25 HBV reactivation patients developed hepatitis. OS in antiviral group was significantly longer than that of non-antiviral group (median 16.46 vs 10.68 months; HR=0.57; 95% CI, 0.36-0.91; p<0.05).

Conclusions: HBV reactivation is more prone to occur in the HBsAg-positive HCC patients undergoing HAIC without antiviral prophylaxis. Regular monitoring of HBV DNA and antiviral prophylaxis are suggested to prevent HBV reactivation as well as prolong the OS of these patients.

Name of the trial register: HAIC Using Oxaliplatin Plus Fluorouracil/Leucovorin for Patients with Locally Advanced HCC.

Clinical trial registration: https://www.clinicaltrials.gov/, identifier NCT02436044.

Keywords: antiviral prophylaxis; hepatic artery infusion chemotherapy; hepatitis B virus reactivation; hepatocellular carcinoma; overall survival.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Liu, Lai, Lyu, Xie, Cao, Chen, He, Zhang and Zhao.

Figures

Figure 1
Figure 1
Flowchart depicting patient deposition. HCC, hepatocellular carcinoma; HAIC, hepatic artery infusion chemotherapy; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus.
Figure 2
Figure 2
Overall survival analysis. Overall survival (OS) comparison between antiviral and non-antiviral groups (A), hepatitis B virus (HBV) reactivation and no HBV reactivation groups (B) using Kaplan-Meier method. OS was calculated from the beginning of HAIC to death resulting from hepatocellular carcinoma (HCC). The difference was significant if p<0.05 by log-rank test.

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