Highlights
- •Post-hepatectomy viral reactivation developed in 9.5% of HBV-infected patients with ICC.
- •Viral reactivation was associated with worse short- and long-term surgical outcomes.
- •Antiviral therapy initiated before surgery reduced the incidence of viral reactivation.
- •Antiviral therapy started either before or after surgery improved survival outcomes.
Background & Aims
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.
Methods
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.
Results
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 (HR 1.23 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).
Conclusions
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.
Lay summary
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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 16, 2017
Accepted:
November 1,
2017
Received in revised form:
October 19,
2017
Received:
April 26,
2017
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
