Background: Hepatitis B virus (HBV) infection remains a public health burden resulting in over 50% of cases of hepatocellular carcinoma (HCC) worldwide. Despite successful HBV suppression with antiviral therapy, there is persistent risk for HCC development in HBV patients and lack of long-term longitudinal assessment. Aim: Assess clinical outcomes after HCC diagnosis in antiviral-treated compared to antiviral-naïve patients. Methods: A retrospective case series was performed observing patients for a period up to 24 years treated at a single tertiary medical center. Selected patients include those diagnosed with chronic hepatitis B (CHB) and HBV-related HCC (HBV-HCC). They were identified as being antiviral-treated or antiviral-naïve at the time of their HCC diagnosis. All patients were treated with nucleos(t)ide analog (NA) therapy after their initial HCC diagnosis. The primary endpoint for this study was death. Clinical characteristics, cumulative patient survival, and equality of survival distribution was assessed between the two groups. Results: A total of 26 patients were identified where 13 were antiviraltreated and 13 were antiviral-naïve at the time of their first HCC diagnosis. 92.3% and 53.8% of antiviral-treated and antiviral-naïve patients, respectively were males. Patients in the antiviral-treated cohort were successfully treated with NA therapy for a median of 8 years prior to their first HCC diagnosis. After their first HBV-HCC event, death was observed more frequently among the antiviral-treated cohort at 46.2% as opposed to 15.4% in the antiviral-naïve cohort. All patients who died during the observation period were male. Of those surviving in the antiviral-treated cohort, 3 patients achieved liver transplantation. HBV-HCC patients previously treated with anti-HBV therapy had poorer survival rates than those naïve to therapy (p=0.008, log rank test=7.057). Conclusion: Poorer survival was observed among antiviral-treated patients with breakthrough HBV-HCC compared to antiviral-naïve HBV-HCC patients. Early referral for liver transplantation is warranted for antiviral treated HBV-HCC patients.
Chronic hepatitis B, Hepatocellular Carcinoma, HBV related HCC, Antiviral therapy, Hepatocarcinogenesis, HBV integration, Gender Disparity, Survival