SAN FRANCISCO, CA—Cirrhotic patients who develop hepatocellular carcinoma (HCC) despite secondary prevention therapy with nucleos(t)ide analog (NUC) treatment appear to have poor recurrence-free survival (RFS) after surgery than those who do not undergo secondary prevention, reported authors of a new study presented at The Liver Meeting® 2015.

“Cirrhotic patients with NUCs-secondary-prevention failure had a higher risk of recurrence after curative resection for HCC,” said I-Cheng Lee, MD, from the Taipei Veterans General Hospital, Taipei, Taiwan. 

“We have to pay more attention to recurrence with these patients,” he said. Physicians and surgeons should advise patients of the higher risk of recurrence associated with cirrhosis, Dr. Lee concluded. “Other adjuvant strategies might be considered for these patients.”

Treatment with NUCs can decrease the risk of HCC in carriers of hepatitis B virus (HBV) as secondary prevention, he noted. Dr. Lee and his coauthors conducted a study of 168 consecutive patients undergoing curative resection for HBV-related HCC while receiving NUCs, 60 of whom had received NUCs for less than 1 year before resection for HCC and continued NUCs after surgery. These patients were categorized as the study’s secondary prevention failure group. 

At baseline (surgery), patients in this NUC secondary-prevention-failure group had significantly smaller tumor size (3.60 vs. 4.75cm; P<0.001), lower HBV DNA (3.36 vs. 5.31 Log IU/mL; P<0.001), and lower ALT (50 vs. 65 U/L; P<0.001) than did the 108 patients who started NUC therapy only after surgery, Dr. Lee noted. 

But in a subsequent multivariate subset analyses of BCLC-A patients matched for cirrhosis status and tumor size, RFS was significantly worse among cirrhotic patients who had undergone secondary prevention NUC therapy (P=0.037), Dr. Lee reported.