Vol 44 # 2 June 2012 - Kma.org.kw

June 2012
KUWAIT MEDICAL JOURNAL 154
Letter to the Editor
Evaluation of Lamivudine Effect on Prevention of
Hepatocellular Carcinoma Recurrence
Kuan-Fu Liao 1,2 , Shih-Wei Lai 3,4
1
Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, 427, Taiwan
2
School of Medicine, Tzu Chi University, Taiwan
3
School of Medicine, China Medical University, Taichung, Taiwan
4
Department of Family Medicine, China Medical University Hospital, Taichung,Taiwan
Kuwait Medical Journal 2012; 44 (2): 154
Limited information is available about the effect of
lamivudine treatment on prevention of hepatocellular
carcinoma (HCC) recurrence in Taiwan. This was
a hospital-based observational study. We analyzed
the medical records of subjects with HCC initially
treated by hepatic resection, were hepatitis B surface
antigen (HBsAg) positive and hepatitis C antibody
positive, at one medical center in Taiwan from 2000
to 2008. The institutional review board of this medical
center approved this retrospective study. In all, seven
subjects received 100 mg/day lamivudine after
hepatic resection (lamivudine group) and 39 subjects
underwent hepatic resection only (control group). The
overall follow-up period was 52 weeks. There were
no significant differences in gender, age, aspartate
aminotransferase, alanine aminotransferase, total
bilirubin, albumin, alpha-fetoprotein, platelet count,
prothrombin time, presence of ascites, Child–Pugh
score, HCC pathological grade [1] and cancer of the liver
Italian program (CLIP) score [2] between the control
group and the lamivudine group at the time of HCC
diagnosis. The mean periods from initial treatment to
recurrence were 32.3 ± 17.5 weeks (range 5 to 52) in the
control group and 31.3 ± 20.6 weeks in the lamivudine
group (range 7 - 52) (p = 0.890). During the followup
period, out of the 46 subjects, 24 subjects (52.2%)
experienced HCC recurrence at the end of 52 weeks
(21 subjects in the control group and three subjects
in the lamivudine group). The cumulative recurrence
rates of HCC at 26 and 52 weeks in the control group
were 33.3% and 53.8%, respectively, while those in the
lamivudine group were 28.6% and 42.9%, respectively.
There were no significant differences regarding the
recurrence rates of HCC between two groups (p =
0.82).
To date, there are few reports regarding the effects
of antiviral therapy on recurrent HCC. Two studies in
Japan have disclosed that the cumulative recurrence
rates of HCC did not significantly differ between the
lamivudine group and the control group [3,4] , which was
compatible with this present study. In Kim’s study,
lamivudine therapy could increase albumin, decrease
ascites and decrease Child-Pugh score in patients with
hepatitis B virus-related HCC [5] . The author concluded
that lamivudine therapy could increase the curative
chance in patients with hepatitis B virus-related
HCC [5] .
To date, according to the above literature [3,4] and
this present study, lamivudine therapy seems to be
not effective in prevention of HCC recurrence after
resection of primary tumor. However, because this
present study is a small sample size, we cannot make a
strong recommendation about the effect of lamivudine
therapy. A larger sample size is needed to confirm
whether antiviral drugs can improve the recurrence
rate.
REFERENCES
1. Edmondson HA, Steiner PE. Primary carcinoma of the
liver: a study of 100 cases among 48900 necropsies.
Cancer 1954; 7:462-503.
2. Cancer of the Liver Italian Program (CLIP) investigators:
A new prognostic system for hepatocellular carcinoma:
a retrospective study of 435 patients. Hepatology 1998;
28:751-755.
3. Kuzuya T, Katano Y, Kumada T, et al. Efficacy of
antiviral therapy with lamivudine after initial treatment
for hepatitis B virus-related hepatocellular carcinoma. J
Gastroenterol Hepatol 2007; 22: 1929-1935.
4. Piao CY, Fujioka S, Iwasaki Y, et al. Lamivudine treatment
in patients with HBV-related hepatocellular carcinoma
- using an untreated, matched control cohort. Acta Med
Okayama 2005; 59:217-224.
5. Kim JH, Park JW, Koh DW, Lee WJ, Kim CM. Efficacy of
lamivudine on hepatitis B viral status and liver function
in patients with hepatitis B virus-related hepatocellular
carcinoma. Liver Int 2009; 29:203-207.
Address correspondence to:
Shih-Wei Lai, Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung, 404, Taiwan. Tel: 886-4-2206-
2121 ext. 4507, Fax: 886-4-2203-3986, E-mail: wei@mail.cmuh.org.tw