title: Use of antiviral therapy in surveillance: impact on outcome of hepatitis B-related hepatocellular carcinoma.
abstract: BACKGROUND
  Antiviral therapy for hepatitis B virus (HBV) infection is frequently prescribed for patients with chronic HBV infection during surveillance for hepatocellular carcinoma (HCC). In patients who subsequently develop HCC, the impact of antiviral therapy on the outcome of HCC remains unclear.
  
  
  OBJECTIVE
  We aimed to study the impact of antiviral therapy on the survival of patients who developed HCC.
  
  
  METHODS
  From two prospective surveillance cohorts, the use of antiviral therapy for patients with HCC was retrospectively reviewed. We compared the overall survival, liver function and tumour characteristics between patients with and without antiviral therapy during surveillance. Multivariate analysis was conducted to determine the independent prognostication of antiviral therapy.
  
  
  RESULTS
  During a median follow-up of 10.1 years of 1429 patients, 148 cases of HCC were diagnosed and followed up for a median of 5.7 years. Twenty-nine patients were given antiviral therapy during surveillance and continued treatment after diagnosis of HCC. The median survival of this group of patients was better than the rest of cohorts (hazard ratio: 0.472; 95% CI: 0.25-0.89; P = 0.0191). Use of antiviral therapy remained an independent prognostic factor after adjustment for demographic factors and tumour staging on multivariate analysis. Exploratory analysis revealed that patients who commenced antiviral therapy during surveillance had lower HBV DNA, lower serum alanine transaminase, better hepatic reserves and higher rate of local treatment at diagnosis of HCC.
  
  
  CONCLUSIONS
  This study provides evidence that commencement of antiviral therapy during the surveillance period is associated with improvement in overall survival in HBV-related HCC.
authors.affiliation: State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. hlychan@cuhk.edu.hk
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.forename: Frankie K F
authors.initials: FK
authors.lastname: Mo
authors.forename: Vincent W S
authors.initials: VW
authors.lastname: Wong
authors.forename: Giok S
authors.initials: GS
authors.lastname: Liem
authors.forename: Grace L H
authors.initials: GL
authors.lastname: Wong
authors.forename: Vicky T C
authors.initials: VT
authors.lastname: Chan
authors.forename: Darren M C
authors.initials: DM
authors.lastname: Poon
authors.forename: Herbert H F
authors.initials: HH
authors.lastname: Loong
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.forename: Anthony T C
authors.initials: AT
authors.lastname: Chan
authors.forename: Tony S K
authors.initials: TS
authors.lastname: Mok
authors.forename: Henry L Y
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D004279:DNA, Viral; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D019562:Viral Load; D057832:Watchful Waiting
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral