Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.714
Peer-review started: September 28, 2020
First decision: November 3, 2020
Revised: November 20, 2020
Accepted: December 11, 2020
Article in press: November 11, 2020
Published online: January 26, 2021
The incidence of hepatocellular carcinoma (HCC) is high in China, and approximately 15%-20% of HCC cases occur in the absence of cirrhosis. Compared with patients with cirrhotic HCC, those with non-cirrhotic HCC have longer postoperative tumor-free survival. However, the overall survival time is not significantly increased, and the risk of postoperative recurrence remains. Strategies to improve the postoperative survival rate in these patients are currently required.
A 47-year-old man with a family history of HCC was found to have hepatitis B virus (HBV) infection 25 years ago. In 2000, he was administered lamivudine for 2 years, and entecavir (ETV 0.5 mg) was administered in 2006. In October 2016, magnetic resonance imaging revealed a tumor in the liver (5.3 cm × 5 cm × 5 cm); no intraoperative hepatic and portal vein and bile duct tumor thrombi were found; and postoperative pathological examination confirmed a grade II HCC with no nodular cirrhosis (G1S3). ETV was continued, and no significant changes were observed on imaging. After receiving pegylated interferon alfa-2b (PEG IFNα-2b) (180 μg) + ETV in February 2019, the HBsAg titer decreased significantly within 12 wk. After receiving hepatitis B vaccine (60 μg) in 12 wk, HBsAg serological conversion was realized at 48 wk. During the treatment, no obvious adverse reactions were observed, except for early alanine aminotransferase flares. The reexamination results of liver pathology were G2S1, and reversal of liver fibrosis was achieved.
The therapeutic regimen of ETV+ PEG IFNα-2b + hepatitis B vaccine for patients with HBV-associated non-cirrhotic HCC following hepatectomy can achieve an HBV clinical cure and prolong the recurrence-free survival.
Core Tip: Patients with hepatitis B virus infection can progress to liver failure, cirrhosis, and hepatocellular carcinoma (HCC); however, not all HCCs originate from cirrhosis, and approximately 15%-20% of HCC cases still occur without cirrhosis. Most importantly, the treatment of non-cirrhotic HCC after surgery and whether the risk of recurrence can be reduced by combining immunomodulators are the urgent problems that need to be solved at present. Therefore, we report a case in which HCC still occurred after 16 years of antiviral therapy, and the combination of immunoregulator therapy after HCC resection achieved a clinical cure and liver fibrosis reversal.