Benefits of entecavir therapy in HBV-related hepatocellular carcinoma patients with compensated cirrhosis after hepatectomy: a ten-year cohort study

Abstract Background Data on the impact of antiviral therapy(AVT) on the long-term outcomes of hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC) patients with cirrhosis after hepatectomy are limited. We aimed to determine the effect of AVT on HBV-related cirrhotic HCC. Methods A total of 1396 patients with HBV-related cirrhotic HCC who underwent curative resection and received entecavir for postoperative AVT were categorized into AVT and no-AVT groups. Recurrence and overall survival(OS) rates were compared, especially according to the initiation time of AVT, virological response, and low HBV levels. Results The 1-, 3-, 5- and 10-year recurrence rates in AVT group(n = 432) were lower than those in no-AVT group(n = 964, 26%, 49%, 65% and 76% vs. 29%, 69%, 87% and 92%,P < 0.001) and OS rates were higher(95%, 69%, 54% and 34% vs. 94%, 53%, 35% and 11%,P < 0.001). AVT was an independent factor for late, but not early, recurrence(P < 0.001). The 3-, 5-, and 10-year recurrence rates were similar between patients with only postoperative AVT and those with both pre-and postoperative AVT(P = 0.772). In the AVT group, the 3-, 5-, and 10-year recurrence rates in patients with persistent virological response(PVR) were lower than those in patients with low detectable viral levels(LDV, P = 0.003). Logistic analysis showed that the time to virological response(P < 0.001) and HBeAg positivity(P < 0.001) were independently associated with LDV. Patients with spontaneous or treatment-induced undetectable HBV showed the lowest and similar late recurrence rates(P = 0.796). Conclusions Long-term AVT, regardless of preoperative or postoperative initiation, reduced post-resection late recurrence in patients with HCC and cirrhosis, especially in those with PVR.