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Abstract Details
State of the art treatment of hepatitis B virus hepatocellular carcinoma and the role of hepatitis B surface antigen post-liver transplantation and resection
Liver Int. 2022 Feb;42(2):288-298. doi: 10.1111/liv.15124. Epub 2021 Dec 20.
1General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
2Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
3Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
4Biotest AG, Dreieich, Germany.
5Department of General and Digestive Surgery, University Hospital 12 de Octubre, Madrid, Spain.
6Keck Hospital of University of Southern California, Los Angeles, California, USA.
7Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.
8Centre Hepatobiliaire, University Hospital Paul Brousse, University Paris-Saclay and Inserm-Paris Saclay Research Unit 1193, Villejuif, France.
Abstract
Chronic hepatitis B virus (HBV) infection is the major aetiology of hepatocellular carcinoma (HCC). The optimal goal of therapy, hepatitis B surface antigen (HBsAg) loss and anti-HBs production, is achieved rarely and HBsAg-associated HCC risk is well recognized. Here we review the role of HBsAg in HCC, the link between HBsAg and HCC recurrence post-liver transplantation or resection, and the implications for therapy. HBV-associated carcinogenesis is a multifactorial process. The observation that HBV-related HCC can occur in the absence of cirrhosis is compatible with a direct oncogenic effect of the virus, which may occur via multiple mechanisms, including those mediated by both mutated and unmutated HBsAg. HCC recurrence in HBsAg-positive patients post-liver transplantation has been reported in 10%-15% of patients and is likely to be because of expansion of residual HCC tumour cell populations containing integrated HBV DNA, which expand and independently replicate HBV, leading to the recurrence of both HCC and HBV. The direct role of HBsAg in HCC recurrence post-liver resection is less clear. Cirrhosis is the most important risk factor for HCC development, and precancerous cirrhotic liver remains after resection, with the potential to undergo malignant transformation regardless of the existence of HBV-derived oncogenic drivers. The role of HBsAg in the development of HCC and its recurrence post-surgical intervention has multiple implications for therapy and suggests a potential role for immunotherapy in the future management of HCC, in particular post-liver transplantation. Use of hepatitis B immunoglobulins that target HBsAg directly, alongside immune-oncology therapies, may be relevant in this setting.