title: Antiviral therapy after curative treatment of hepatitis B/C virus-related hepatocellular carcinoma: A systematic review of randomized trials.
abstract: OBJECTIVE
  Available published work on the benefit of adjuvant antiviral therapy after curative treatment of hepatocellular carcinoma (HCC) reports controversial results. The objective of this systematic review was to evaluate the effect of adjuvant antiviral therapy on recurrence and survival after curative treatment of HCC.
  
  
  METHODS
  We conducted an extensive search strategy. All randomized controlled trials comparing adjuvant antiviral therapy versus placebo or no treatment were considered for this review. Results were expressed as hazard ratio for time-to-event outcomes with 95% confidence intervals using RevMan 5.
  
  
  RESULTS
  We included nine trials (three of low risk of bias and six of unclear risk of bias) with 954 patients. All the included studies used conventional interferon (IFN) as adjuvant antiviral therapy; none of them used pegylated IFN or nucleoside analogs. There were significant improvements for recurrence-free survival and overall survival in the adjuvant IFN group compared with the control group. Subgroup analysis also showed a significant difference favoring IFN therapy in hepatitis C virus (HCV)-related HCC patients, but for hepatitis B virus (HBV)-related patients, the difference failed to reach statistical significance. A dose reduction was needed in 28.3% of patients and discontinuation of IFN therapy happened in 8.2% of patients due to moderate to severe side-effects.
  
  
  CONCLUSIONS
  Our study suggested potential benefits of adjuvant IFN therapy following curative treatment of HCC, especially for HCV-related HCC. Further high-quality randomized controlled trials of more effective adjuvant antiviral regimens, either used alone or in combination, for virus-related HCC, especially HBV-related HCC, are needed.
authors.affiliation: Hepatobiliary Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.forename: Rui-Qing
authors.initials: RQ
authors.lastname: He
authors.forename: Qing-Gang
authors.initials: QG
authors.lastname: Hu
authors.forename: Zi-Fang
authors.initials: ZF
authors.lastname: Song
authors.forename: Jun
authors.initials: J
authors.lastname: Xiong
authors.forename: Qi-Chang
authors.initials: QC
authors.lastname: Zheng
keywords: antiviral agent; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; interferon