Background: This retrospective study was aimed to investigate the efficacy of prophylactic agents inhepatocellular carcinoma (HCC) patients receiving TACE and compare the difference between lamivudine andentecavir. Materials and
Methods: A consecutive series of 203 HBV-related HCC patients receiving TACE wereanalyzed including 91 patients given prophylactic agents. Virologic events, defined as an increase in serum HBVDNA level to more than 1 log10 IU/ml higher than the nadir level, hepatitis flares due to HBV reactivation andprogression free survival (PFS) were the main endpoints.
Results: Some 48 (69.6%) reached virologic response.Prophylaxis significantly reduced virologic events (8.8% vs 58.0%, p=0.000) and hepatitis flares (1.1% vs 13.4%,p=0.001). Patients presenting undetectable HBV DNA levels displayed a significantly improved PFS as comparedto those who never achieved undetectable HBV DNA. Prophylaxis and e-antigen positivity were the only significantvariables associated with virologic events. In addition, prophylaxis was the only independent protective factor forhepatitis flares. Liver cirrhosis, more cycles of TACE, HBV DNA negativity, a lower Cancer of the Liver ItalianProgram score, non-metastasis and no hepatitis flares were protective factors for PFS. Prophylactic lamivudinedemonstrated similar efficacy as entecavir.
Conclusions: Prophylactic agents are efficacious for prevention ofHBV reactivation in HCC patients receiving TACE. Achievement of undetectable HBV DNA levels displayeda significant capability in improving PFS. Moreover, persistent tumor residual lesions, positive HBV DNA andhepatitis B flares might be causes of tumor progression in these patients.