Perioperative antiviral therapy for chronic hepatitis B-related hepatocellular carcinoma

摘要

BACKGROUND: After  effective  treatment  with  antiviral agent,  patients  with  low  serum  hepatitis  B  virus  (HBV)  DNA level  had  a  low  incidence  of  hepatocellular  carcinoma  (HCC). HBV  reactivation  after  HCC  surgery  is  associated  with  HCC recurrence.  To  date,  there  are  no  universal  guidelines  for  the perioperative  antiviral  treatment  of  patients  with  chronic hepatitis  B,  let  alone  antiviral  therapy  in  patients  with  HBV-related  HCC.  The  present  analysis  is  trying  to  develop  a perioperative anti-HBV treatment protocol. DATA SOURCES: A literature search of PubMed was performed, the key words were "perioperative" "antiviral therapy", "hepato-cellular  carcinoma"  and  "chronic  hepatitis  B".  All  of  the information was collected. RESULTS: Relevant  documents  showed  that  reactivation  of HBV replication played a direct role in the late recurrence of HCC  after  surgical  resection.  The  well  control  of  viral  load before  and  after  operation  significantly  increased  tumor-free survival.  Many  drugs  are  used  in  antiviral  therapy  including interferon  alpha  and  nucleoside  analogues.  Foscarnet,  two-agent or even multiagent of nucleoside analogues is necessary for  perioperative  antiviral  treatment  of  patients  with  chronic hepatitis B related HCC. CONCLUSIONS: HBV reactivation after HCC surgery induces hepatitis  flare  and  hepatocarcinogenesis,  thus  lifelong  and vigorous  control  of  HBV  is  very  important  in  patients  with chronic hepatitis B and HBV-related HCC. A uniform guideline is  necessary  to  rapidly  reduce  HBV  DNA  to  a  lower  level  in perioperation.