Journal of Liver Cancer

Original Article

Occurrence Rates of Hepatocellular Carcinoma in Patients with Adefovir-rescue Therapy for Lamivudine-Resistant Chronic Hepatitis B: Jihyun Kim, Sae Hwan Lee, Kanghyug Choi, Yun Nah Lee, Soung won Jeong, Sang Gyune Kim, Jae Young Jang, Young Seok Kim, Hong Soo Kim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):130-135. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.130

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Abstract PDF: Background/Aims
Suboptimal virological response to adefovir (ADV) rescue therapy was commonly experienced in patient with lamivudine-resistant chronic hepatitis B. The aim of this study is to compare occurrence of hepatocellular carcinoma (HCC) of patients with adefovir rescue therapy to naïve patients with entecavir.
Methods
Electronic medical records of 156 patients with lamivudine-resistant chronic hepatitis B who treated with ADV and of 186 naïve-patients who received entecavir 0.5 mg, as control group, were reviewed retrospectively. Study subjects were matched using estimated propensity score and 107 matched subjects in each group were analyzed. Cumulative occurrence of HCC was evaluated during antiviral therapy and the association between clinical variables and development of HCC were analyzed using Kaplan-Meyer curve and risk factor for HCC was evaluated with Cox-proportional hazard model.
Results
Age, gender, Child-Pugh score, underlying cirrhosis, HBeAg, and HBV DNA level were not different in both groups, except treatment duration with ADV or entecavir (mean 52.6±17.5 vs 46.7±11.4 months, P=0.004). Cumulative virological response rates were 16% and 42% in patient with ADV rescue therapy and 68% and 85% in naïve-patients received entecavir at 1 and 3 years (P<0.001), respectively. HCC were diagnosed in 6 of 107 patients with lamivudine-resistance and 9 of 107 naïve-patients during follow-period and cumulative occurrence rates of HCC was not different between both group (P=0.308). Cumulative occurrence rates of HCC in total 214 subjects were 2.3%, 4.8%, and 9.6% at 1, 3, and 5 years, respectively. Age, underlying cirrhosis, and baseline HBV DNA level were associated with the occurrence of HCC, however gender, HBeAg status, ADV rescue therapy, and cumulative virological response were not correlated in univariate analysis. In multivariate analysis, age (P=0.008) and underlying cirrhosis (P=0.002) were independent risk factors for occurrence of HCC.
Conclusions
Long-term ADV rescue therapy in patients with lamivudine-resistant chronic hepatitis B did not increase the occurrence rates of HCC.

Case Report

Two Cases of Acute Hepatic Decompensation after Concurrent Chemoradiotherapy in Patients with Advanced Hepatocellular Carcinoma: Myoung Hwan Kim, Sang Hoon Ahn, Yong Han Paik, Kwan Sik Lee, Chae Yoon Chon, Young Myoung Moon, Jinsil Seong, Kwang Hyub Han; Journal of the Korean Liver Cancer Study Group. 2005;5(1):52-56. Published online June 30, 2005

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Abstract PDF: Advanced hepatocellular carcinoma with portal vein thrombosis has a poor prognosis. Concurrent chemoradiation (CCRT) therapy achieved favorable results in advanced hepatocellular carcinoma with portal vein thrombosis and can be considered as a treatment option for the management of advanced hepatocellular carcinoma.2 But, exacerbation of liver function during concurrent chemoradiotherapy is a critical complication in patients with hepatitis B virus (HBV) related HCC. Reactivation of HBV replication is a well-known complication in cancer patients receiving chemotherapy. We report two cases with acute exacerbation of liver function. The one
result
ed in hepatic decompensation after CCRT probably due to HCC progression and/or chemoradiotherapy and the other is due to reactivation of HBV replication after CCRT, who recovered after lamivudine and corticosteroid therapy.

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