I. Preface
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection play an important role in the development of hepatocellular carcinoma (HCC). The Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2010 Edition) and the Code of Practice for the Treatment of Primary Liver Cancer (2011 Edition) released in China in recent years both emphasize the importance of antiviral therapy for patients with hepatocellular carcinoma, and the Guidelines for the Prevention and Treatment of Hepatitis C (2004 Edition) also note that antiviral therapy can delay the development of HCC.
At present, there is no uniform understanding of the specific implementation and evaluation of antiviral therapy for hepatocellular carcinoma at home and abroad. In view of this, the Hepatology Group of the Hepatology Branch of the Chinese Medical Association held three symposiums to systematically collect and analyze the existing clinical research literature on antiviral therapy in the comprehensive treatment of HCC, review the progress of clinical application of antiviral drugs in the treatment of HCC, and base on the available evidence-based medical clinical data on antiviral therapy for virus-associated HCC.
The opinions of some experts were synthesized, refined and supplemented according to the GRADE system of evidence-based medical evidence grading (Table 1), and the Expert Recommendations on Antiviral Therapy for HBV/H CV-related Hepatocellular Carcinoma were launched for the application of antiviral therapy in these patients for discussion, modification and supplementation by domestic experts.
In January 2013, under the direct participation and guidance of Academician Wu Mengchao and Academician Tang Zhaoyou, through the Hepatology Group of the Chinese Medical Association Hepatology Branch, the Hepatology Group of the Surgery Branch, the Interventional Group of the Radiology Branch, the Interventional Group of the Ultrasound Medicine Branch, and the Hepatocellular Carcinoma Specialty Committee of the Chinese Anti-Cancer Association, the Collaborative Specialty Committee of Clinical Oncology (now named the Chinese Clinical Oncology Association), and the Interventional Oncology Specialty Committee The experts from the Chinese Medical Association Oncology Branch Hepatocellular Carcinoma Group and the Organ Transplantation Branch Liver Transplantation Group joined the discussion.
The Expert Consensus on Antiviral Therapy for HBV/HCV-Related Hepatocellular Carcinoma (hereinafter referred to as the Expert Consensus) was formed after many revisions and additions based on the Expert Recommendations, with a view to providing guidance for clinical application of antiviral therapy and further improving the treatment norms for primary liver cancer, the guidelines for the prevention and treatment of chronic hepatitis B and the guidelines for the prevention and treatment of hepatitis C. implementation.
Persistent HBV and/or HCV infection is an important risk factor for the occurrence, development and recurrence of HCC, and moreover, a risk factor for death in HCC patients, so reducing HBV/HCV replication levels is one of the key means to prevent and treat I{BV/HCV-associated HCC. Suppression of viral replication can reduce liver inflammatory activity, reverse liver fibrosis, reduce the incidence of end-stage liver disease events, and reduce the incidence of HCC, which can help improve the overall survival of patients with HBV/HCV-associated HCC.
Recommendation 1: The overall goal of applying antiviral therapy in patients with HBV/HCV-associated HCC is to suppress HBV/HCV replication to the lowest level through antiviral therapy based on comprehensive treatment for HCC, aiming to reduce recurrence of HCC, reduce HBV/HCV reactivation, control disease progression, improve quality of life, and prolong survival (1, A); antiviral therapy can improve liver function, reduce the occurrence of end-stage liver disease events, and create conditions for comprehensive treatment of HCC (1, B).
II. Secondary prevention of HBV/HCV-associated HCC
Chronic HBV infection is one of the major pathogens in the development of HCC. A large sample of natural history studies in Taiwan showed that the incidence of HCC in patients with chronic hepatitis B (CHB) was (403 – 470)/105 . Virological factors contributing to the occurrence of HBV-associated HCC include: HBV DNA level, duration of HBeAg positivity, viral genotype, c-region promoter variants, x-gene variants, etc. The incidence of HCC in patients with HBV-associated cirrhosis is as high as (820 – 2247)/105.
HCV infection is closely related to the occurrence of HCC. Currently, there are about 1.3 – 2.1 billion HCV chronic infections in the world, and about lO-40% of chronic hepatitis C (CHC) patients progress to cirrhosis, and l-5% progress to HCC. The risk of HCC in HCV chronically infected patients is 15 – 20 times higher than that in the general population, and the incidence of HCC in HCV infected patients is 1 – 3% during 30 years of follow-up.
The incidence of anti-HCV positivity in Chinese patients with HCC is approximately 4% – 10%, and the annual incidence of HCC in patients with HCV-associated cirrhosis is 1-4%. Available evidence suggests that serum HCV RNA positivity at any level is an important risk factor for HCC and that HCV clearance may reduce the incidence of HCC.
Antiviral therapy has been well documented to reduce the risk of HCC in patients with cHB and CHC. Several clinical guidelines have identified antiviral therapy as an important tool to prevent and treat HBV/H CV-associated HCC. Thus, antiviral therapy can be used as a secondary prevention measure against HBV/HCV-associated HCC.
Recommendation 2: Antiviral treatment of chronically infected patients with HBV and HCV according to the treatment regimen selected in the Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2010 edition) or the Guidelines for the Prevention and Treatment of Hepatitis C (2004 edition) is an important secondary preventive measure against the occurrence of HBV/HcV-associated HCC (1, A).
Antiviral therapy for patients with HBV-associated HCC
There are two classes of antiviral drugs used for HBV-associated HCC: the IFN alpha (IFNα) and the nucleoside (acid) analogs (NAs). The current NAs for anti-HBV therapy are: lamivudine (LAM), afuvirtide (ADV), entecavir (ETV), and telbivudine (LdT). Tenofovir (TDF) has been newly approved by the China Food and Drug Administration (CFDA) for marketing in anti-HBV therapy.
A randomized controlled clinical study (RCT) showed that the application of NAs improved the survival rate of patients with postal V-associated HCC. a small sample RCT of HBV-associated HCC by Koda et al. showed that the mean Child-Pugh score was significantly improved in the LAM-treated group compared with the control group (p=0,023), and the cumulative survival rate was significantly higher compared with the control group (p=0,02), but the difference in cumulative relapse-free survival between the two groups was not statistically significant. However, the difference in cumulative relapse-free survival between the two groups was not statistically significant.
Koda et al. also found that 39,3% of patients developed drug resistance variants during LAM application, and that strong drugs with high resistance barriers should be preferred because of HBV. A meta-analysis suggested that the use of NAs in patients with HBV-associated HCC may reduce the relapse and mortality rates.
The recurrence rate of HCC in the NAs group (55%) was lower than that in the control group (58%) (p=o,04), with an OR of 0,59 (95% CI 0,35-0,97), and the overall mortality rate was significantly lower in the NAs group (38%) than in the control group (42%).
Wu et al. 2012 reported on the application of NAs to a large sample of HCC after radical HBV-associated HCC surgery. The study group collected 100,938 patients diagnosed with Hcc in Taiwan from 2003 to 2010, of which 4,569 cases of HBV-associated HCC were treated with radical surgery and 518 cases were treated with NAs after surgery (mean treatment time 1.45 years), while 4051 cases in the control group were not given NAS.
After follow-up observation, the recurrence rate of HCC was 20.5% in the NAs group and 43.6% in the control group.
Cox regression analysis suggested that NAs application was an independent influencing factor in reducing HCC recurrence (HR, 0, 67; 95% CI, 0, 55 to 0, 81; p<0, 001). In a case-control study by Li et al. in which residual liver volume was observed after radical HBV-associated HCC treatment with NAs, the increment of residual liver volume was (78,0±40,1) cm3/m3 in the NAs group (43 cases) and (35,8±56,0) cm3/m2 in the control group (36 cases) at 6 months after surgery (p=0,009), suggesting that the application of NAs contributed to the increase of residual liver volume and improved Jang et al. randomly grouped patients treated with percutaneous hepatic artery chemoembolization (TACE), and LAM was given to the treatment group.
It was found that 11 cases (29, 7%) in the control group (37 cases) had a postoperative hepatic inflammatory response due to active HBV replication, while only 1 case (2, 8%) in the LAM group (36 cases) had hepatitis activity (p=0, 002).
This study concluded that LAM reduced the risk of liver failure induced by inflammatory response after TACE in patients.Xia et al. showed that after percutaneous radiofrequency ablation (RFA) treatment of small hepatocellular carcinoma, the 1-, 3-, and 5-year tumor-free survival rates were 86, 8%, 41, 2%, and 22, 8% in the HBV DNA high-carrier group (≥105 copies/ml), and the cumulative overall survival rates were 88, 5%, 64, 3%, and 32, 2%, respectively. The cumulative overall survival rates were 88, 5%, 64, 3%, and 32, 2%, respectively.
In contrast, the tumor-free survival rates at 1, 3 and 5 years in the low carrier group (<105 copies/ml) were 96.4%, 65.8% and 36.7%, and the cumulative survival rates were 90.9%, 66.7% and 21.7%, respectively, suggesting that high viral load affects recurrence after radical treatment of hepatocellular carcinoma, but not overall survival.
IFN α has a role in preventing recurrence after radical treatment of HCC. In the Sun et al. RCT study, which selected patients after radical HCC treatment, the recurrence rate was 36,40% in the IFN α group at 18 months of treatment compared with 49.2% in the control group (p=0,0485); at 18 months of follow-up after discontinuation of IFN α, the recurrence rate was 32,9% in the IFN α group compared with 23,2% in the control group (p=o.2292).
In the Lo et al. RCT, HCC patients with the same TNM stage were randomized to the lFN α group and the control group after resection, and the treatment regimen was IFNα-2b at 10MIU/m2, 3 times a week for 16 weeks. 20% (8/40) of patients in the treatment group died or had liver transplantation at the end of the 5-year follow-up, compared with 33% (13/40) in the control group; the survival rates at 1, 3, and 5 years were 97%, 79% and 79% in the IFNα group and 85%, 70% and 61% in the control group, respectively, with no statistically significant difference between the two groups (p=o. 137).
However, for patients with TNM stage III/IVA, the 1-, 3- and 5-year survival rates were 95%, 68% and 68% in the IFNα group and 68%, 47% and 24% in the control group, respectively, with a statistically significant difference between the two groups (p=o.038).
Therefore, the application of IFNα after radical surgery in patients with HBV-associated HCC can reduce the recurrence rate of HCC and help improve patient survival. the main virological factors for recurrence of HBV-associated HCC are high viral load and HBeAg positivity.
Some studies have investigated the combined effect of antiviral therapy. kim et al. reviewed the 0 results of preferred RFA treatment in 1305 HCC patients over 12 years (April 1999 to April 2011). 1502 lesions with a mean lesion size of 2,2 cm (0,5-4,9 cm) were found in this group, 206 of which were confirmed by liver biopsy.
1077 patients (82.5%) had a background of cirrhosis, 912 (69.6%) were HBV-infected, and 233 (17.8%) were HCV-infected. 1283 of the 1305 patients completed RFA and survived for more than 30 d, of which 795 (62.0%) had relapses. Among the relapsed patients, 154 (19.4%) had progression of the original lesion and 535 (67.3%) had distant intrahepatic relapses.
After multiple treatment regimens, 245 cases did not recur, 509 cases (67,5%) had more than 2 recurrences, and 344 cases had more than 3 recurrences. Multifactorial analysis suggested that older age, Child_Pugh class B, failure to apply antiviral therapy after RFA treatment and the presence of extrahepatic metastases before RFA treatment were the main risk factors for poor survival. This study suggests that even in HCC patients with Barcelona clinical liver cancer (BCLC) stage 0 or A who have been treated locally with RFA, antiviral therapy should still be administered to reduce HCC recurrence and improve survival.
HBV reactivation should be guarded against in some patients with HBV-associated HCC who are tested negative for HBV DNA. The mechanism for this is the persistence of covalent closed-loop DNA (cce DNA) in the nucleus of hepatocytes. overseas studies in the 1990s showed that the incidence of HBV reactivation in patients with HBV-associated HCC after radical surgery was about 2%, and the rate of HBV reactivation in a small sample in China was reported to be 14 or 3%.
The rate of HBV reactivation after TACE in patients with HBV-associated HCC was higher, about 15% – 30%. jang et al. reported a rate of HBV reactivation after TACE of 33,7%. lao et al. retrospectively investigated a group of 172 patients with HBV-associated HCC and HBV reactivation occurred in 14,50% after TACE. multivariate analysis showed that the preoperative baseline level of HBV DNA and HBeAg status were the main factors influencing HBV reactivation.
Kim et al. reported a HBV reactivation rate of 21.8% in HBV-associated HCC patients treated with three-dimensional conformal radiotherapy (3D-CRT), and Yeo et al. reported a HBV reactivation rate of 36% in HBV-associated HCC patients treated with systemic chemotherapy. application of NAs before, during or after TACE reduced HBV reactivation, and application of NAs before or during radiotherapy prevented The application of NAs before or during radiotherapy can prevent the reactivation of HBV.
Antiviral therapy has received increasing attention in HCC clinical practice, and in 2013, our scholars accumulated more clinical data confirming that antiviral therapy can reduce the recurrence rate and morbidity and mortality of HBV-associated HCC. Yin et al. evaluated the impact of antiviral therapy with NAs on the prognosis of HBV-associated HCC patients treated surgically through a two-stage longitudinal study including RCT. High-load HBV DNA was a predictor of reduced overall survival (OS) and relapse-free survival (RFS) in HCC patients, and antiviral therapy significantly improved the prognosis of patients.
The 4-year Os and RFS in the NAs group in non-RCT were 59, 6% and 37, 2%, respectively, compared with 46, 6% and 16, 6% in the control group, with statistically significant differences.
The study showed that the duration of response to antiviral therapy was closely related to postoperative recurrence of HCC, and the postoperative recurrence rate was significantly higher in patients whose HBV DNA levels had not been reduced to undetectable after 24 weeks of medication than in those who had been reduced to undetectable, and in patients who had developed drug resistance than in those who had not.
Surgical treatment may also lead to HBV reactivation in HCC patients with low viral load (HBV DNA < 2000 IU/ml), whose overall survival and disease-free survival rates are significantly lower than those of patients without HBV reactivation, thus emphasizing that rapid, potent, and low-resistant antiviral drugs should be preferred.
The incidence of HBV reactivation after RFA treatment was significantly lower than that of hepatectomy patients. Prophylactic antiviral therapy can effectively reduce the incidence of HBV reactivation in hepatectomy HCC patients.
In conclusion, the application of antiviral therapy in patients with HBV-associated HCC has two clinical implications: (l) to prevent or reduce recurrence of HCC, especially distant recurrence, improve liver function, and increase patient survival; and (2) to reduce HBV reactivation due to antitumor therapy and decrease the incidence of end-stage liver disease events. The clinical timing and regimen of antiviral therapy (antiviral therapy applied concurrently with antitumor treatment measures or after phased implementation of antitumor therapy) needs to be decided on a patient-by-patient basis.
Recommendation 3: NAs for patients with HBV-associated HCC can be administered with lamivudine (LAM). Adefovir (ADV), telbivudine (LdT) and entecavir (ETV), tenofovir (TDF) is also an option when available. It is recommended to give preference to potent high resistance barrier drugs (ETV or TDF). the principles of monitoring, side effects and management during the treatment of NAs are described in the Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2010 Edition).
1. HBV-associated HCC patients tested positive for FBV DNA should all be given NAs antiviral therapy on the basis of a comprehensive HCC treatment regimen (1, A). It is recommended to refer to the principles of treatment of HBV-associated cirrhosis in the Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2010 edition) and to choose NAs for long-term administration (2a, A). Patients should be treated with NAs as early as possible in their anti-tumor therapy to reduce HBV DNA levels in order to reduce HBV reactivation (2a, A).
2. For HBV-associated HCC diagnosed and tested negative for HBV DNA after receiving TACE, radiation therapy or systemic chemotherapy, it is recommended to start treatment with NAs promptly before treatment to avoid HBV reactivation. HBV DNA needs to be monitored closely during and after treatment, and if HBV DNA is negative during and after the second examination (one month apart), NAs treatment can be stopped or continued for 6 months depending on the condition; if HBV DNA turns positive during monitoring, the patient needs long-term treatment (2a, B). For those who undergo ablation therapy, HBV reactivation should be given high priority and HBVDNA should be closely monitored; if HBV DNA is positive during monitoring and remains positive at a 2-week interval between retests, long-term treatment with NAs can be selected (2a, B).
3. Patients with confirmed HBV-associated HCC who meet the criteria for liver transplantation and are proposed for liver transplantation should be given NAs preoperatively to lower the patient’s FBV DNA level as much as possible if the HBV DNA test result is positive (1, A). LAM should be given as early as possible before liver transplantation, and other NAs should be promptly selected if the DNA is high preoperative load or has become resistant; HBV highly effective immunoglobulin (HBIG) should be given during the intraoperative liver-free period: long-term postoperative LAM and HBIG should be used to prevent HBV reactivation (2a,B).
For those who develop LAN resistance, ADV combination therapy may be added (2a,B). ETV or TDF alone, combined with or without low-dose FBIG, can also better prevent HBV reactivation after liver transplantation (2a, B).
Recommendation 4: FNa(1, A) adjuvant therapy can be chosen in the comprehensive treatment plan for patients with HBV-associated HCC if there is no contraindication to its application. Patients with compensated liver function are recommended to apply IFN α at conventional doses; patients with Child-Pugh score B are recommended to start with a small dose and gradually increase it to 5 MU, 3 times a week, for 6-18 months. IFN α treatment up to 12 weeks, if the patient is still tested positive for HBV DNA, it is recommended to add NAs (except LdT) or switch to NAs treatment (2a, B).
The monitoring program, side effects and management principles during the treatment are referred to the “Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2010 edition)”. If patients are confirmed to have no background of cirrhosis, polyethylene glycol (Peg) IFNα therapy can be chosen.
IV. Antiviral therapy for patients with HCV-associated HCC
Retrospective studies suggest that antiviral therapy will improve survival in patients with HCV-associated HCC. tanimoto et al. 2012 reviewed the prognosis of 175 patients with HCV-associated HCC after surgical resection. to avoid selection bias, the standard treatment regimen (sOc) group (Peg-IFN α2b (1,5 u g/kg) combined with ribavirin (RBV) was compared with the control group A 1:1 paired analysis was performed according to gender, age, and tumor diameter.
A total of 38 pairs of patients were included in the analysis, and the comparison revealed that the 3- and 5-year survival rates were 100% and 76, 6% in the treated group and 91, 7% and 50, 6% in the untreated group, respectively, with statistically significant differences between the two groups, but no statistically significant differences were found when comparing the recurrence-free survival rates between the two groups (p=0, 886).Haghara et al. retrospectively analyzed the effect of Peg-IFNα on HCV associated HCC patients.
Thirty-seven patients in the treatment group were treated with Peg-IFN α postoperatively and 145 in the control group were not treated. The follow-up results showed that the 5-year survival rates were 91% and 56% in the treatment and control groups, respectively (p < 0, 01; the rate of 2nd relapse was significantly lower in patients who achieved durable virological response (SVR) with Peg-IFN α treatment than in the control group (p = 0, 03).
The results of the meta-analysis confirmed that antiviral therapy reduces the recurrence rate of HCV-associated HCC and improves patient survival.Singal et al. collected 10 clinical studies for meta-analysis, and the valid cases analyzed were 645 patients with HCV-associated HCC, 301 of which were treated with IFN α alone or in combination with RBV.
The analysis showed that postoperative application of IFN α resulted in a decrease in HCC recurrence rate with an OR of 0,26 (95% CI 0,15 to 0,45, p < 0,00001; in terms of 5-year survival, the results of 505 patients from 6 studies showed that IFN α treatment was an important factor affecting prognosis. Patients who obtained SVR with IFN α treatment had a significantly lower HCC recurrence rate (p=0, 005) and a significantly higher survival rate (p=0, 03) than those who did not obtain SVR.
Miyake et al. selected a meta-analysis of patients whose primary HCC lesions met the Milan criteria, and a total of 355 patients in 5 clinical studies, of whom 167 were treated with IFN α after radical surgery, showed that IFN α treatment significantly reduced the HCC recurrence rate (RR0, 33; 95% CI0, 19 to 0, 58, P<0, 0001). < div="">
More literature confirms that IFN α antiviral therapy improves survival in patients with HBV/HCV-associated HCC. Zhang et al. summarized the results of 6 RCTs, a meta-analysis of 600 patients with HBV/HCV-associated HCC, showing that the application of IFN α after radical surgery prevented the early relapse rate (OR=0,62,95% CI0,42-0,93, P=0,02 ) and improved 1-year survival (OR=3,14,95% CI1,79~5,52, p<0,0001). < div="">
Breitenstein et al. performed a meta-analysis of RCTs of HBV/HCV-associated HCC with postoperative application of IFN α. The analysis including 620 patients from 7 clinical studies showed that postoperative application of IFN α improved 2-year survival with a relative risk ratio (RR) of 0, 65 (95% CI 0, 52 to 0, 80, p<0, 001); IFN α reduced the 2-year recurrence rate in HCC patients with an RR of 0,86 (95% CI 0,76-0,97, P=0,013).
The analysis also pointed out that about 8-20% of patients were unable to complete treatment due to excessive IFN adverse effects. Therefore, the role of antiviral therapy in the overall treatment of virus-associated HCC should be emphasized.
In the guidelines for the antiviral treatment of HCV-associated liver disease transplantation, Watt et al. state that the criteria for HCV recurrence after transplantation are based on pathologically confirmed liver tissue biopsy or positive serum HCV RNA with liver fibrosis ( METAVIR score system ≥3). A treatment regimen with IFN alpha as the core drug is recommended only if these criteria are met, with preference for SOC.
Recommendation 5: HCV-associated HCC should be treated with either SOC (Peg-IFN α-2a/2b combined with RBV) or IFN α combined with RBV, or Peg-IFN α/ IFN α alone for those who cannot tolerate RBV. The testing items, side effects and management principles during anti-HCV treatment are according to the “Hepatitis C Prevention and Control Guidelines (2004 Edition)” (1, A).
1. Patients with HCV RNA-positive HCC should be treated with anti-HCV therapy based on comprehensive treatment such as surgical resection, local ablation, and TACE (2a, A). The patient’s liver pathophysiology and physiology should be evaluated before antiviral therapy, and the antiviral treatment plan should be arranged by the specialist; patients with Child-Pugh grade B liver function should be treated with a low dose initiation step-up strategy, gradually increasing the dose of IFN α/Peg- IFN α in order to obtain a higher SVR and improve the patient’s tolerance to anti-HCV therapy (2a, B); patients with Child-Pugh grade C should not be treated with anti-HCV therapy (2a, B). Pugh score C, IFN α/Peg- IFN α is not recommended to avoid the risk of serious adverse events. Those with negative serum HCV RNA do not need antiviral therapy.
2. Patients with HCV-associated HCC with a liver function Child-Pugh score ≤7 and intended for liver transplantation should be treated with preoperative antiviral therapy (2a,B). Serum HCV RNA levels must be tested after liver transplantation, and liver tissue biopsy should be performed if positive for HCV RNA. Those with active liver fibrosis should be treated with antiviral therapy (2a,B) according to the Child-Pugh score with reference to recommendations 5 and 1.
Recommendation 6: For HCC patients with HBV/HCV overlap infection, the degree of cirrhosis and liver function status should be evaluated on the basis of comprehensive treatment. In patients with Child-Pugh class A who are positive for both serum HBV DNA and HCV RNA, it should be determined which virus is predominant before deciding on a treatment plan. For those with high HBV DNA levels and detectable HCV RNA, it is appropriate to treat with Peg- IFN α and RBV for 3 months, and add NAs if HBV DNA is non-responsive or elevated.
If HCV RNA is positive and HBV DNA is negative, it is advisable to treat with anti-HCV regimen first; if HCV RNA is negative and HBV DNA is positive, it is recommended to refer to the disposition of HBV-associated HCC antiviral regimen mentioned above (2a,C).
V. Prospects for antiviral applications in patients with HBV/HCV-associated HCC
In summary, based on the results of clinical studies on the application of antiviral therapy in HBV/HCV-associated HCC in recent years, the group agreed that antiviral therapy should be emphasized during the diagnosis and treatment of these patients and included in the standardized comprehensive treatment plan for HCC. the significance of antiviral therapy for patients with HBV/HCV-associated HCC is to: reduce the recurrence rate of virus-associated HCC, reduce the incidence of end-stage liver disease events The significance of antiviral therapy for HBV/HCV-associated HCC patients is to reduce the recurrence rate of virus-associated HCC, reduce the incidence of end-stage liver disease events, improve the safety of comprehensive treatment for patients and create conditions for other comprehensive treatments.
However, many questions remain to be elucidated in this field: whether suppression of viral replication is causally related to the reduction of long-term relapse in HCC, the indications for antiviral therapy in HBV DNA-negative HCC and the choice and duration of optimal regimens, how to improve the tolerability and safety of IFN α application in patients with HCC in the context of cirrhosis, the effectiveness of IFN-free regimens in the HCV-associated HCC patient population, and the effectiveness of IFN-free regimens in the HCV-associated HCC patient population. HCC patient population, and the long-term comprehensive management of antiviral therapy for HCC, these issues still need to be summarized by further clinical studies providing new evidence-based medical evidence.
In conclusion, antiviral therapy must be emphasized in the treatment of HBV/HCV-associated HCC, and multidisciplinary physicians should discuss testing and treatment protocols to control disease progression, prevent HCC recurrence, improve patients’ quality of life, and minimize morbidity and mortality through a comprehensive treatment plan that includes antiviral therapy.
Hepatocellular carcinoma antiviral treatment expert group members: Hepatocellular carcinoma group of the Chinese Medical Association’s hepatology branch, liver group of the surgery branch. Interventional Group of Radiology Branch, Interventional Group of Ultrasound Medicine Branch, Hepatocellular Carcinoma Group of Oncology Branch. Liver Transplantation Group of Organ Transplantation Branch; Professional Committee of Chinese Anti-Cancer Association, Collaborative Committee of Clinical Oncology, Professional Committee of Tumor Intervention.