Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 714-721
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.714
Clinical cure and liver fibrosis reversal after postoperative antiviral combination therapy in hepatitis B-associated non-cirrhotic hepatocellular carcinoma: A case report
Xue-Ping Yu, Qi Lin, Zhi-Peng Huang, Wei-Shan Chen, Ming-Hui Zheng, Yi-Juan Zheng, Ju-Lan Li, Zhi-Jun Su
Xue-Ping Yu, Qi Lin, Ming-Hui Zheng, Yi-Juan Zheng, Ju-Lan Li, Zhi-Jun Su, Department of Infection Diseases, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
Zhi-Peng Huang, Department of Gastroenterology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
Wei-Shan Chen, Department of Pathology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
Author contributions: Yu XP, Lin Q, and Su ZJ performed the postoperative evaluation and diagnosis; Huang ZP and Chen WS pathologically diagnosed the tissue; Zheng MH, Zheng YJ, and Li JL collected the medical data; Yu XP and Su ZJ reviewed the literature and contributed to manuscript drafting; Yu XP and Huang ZP contributed equally to this article; and all authors issued final approval for the submitted version.
Supported by Natural Science Foundation of Fujian Province, No. 2019J01593; High-Level Talent Innovation Project of Quanzhou, No. 2018C067R; Science and Technology Innovation Joint Project of Fujian Province, No. 2019Y9048; Youth Research Project of Fujian Provincial Health Commission, No. 2018-1-94 and No. 2018-1-95; Science and Technology Project of Quanzhou, No. 2018Z074 and No. 2018Z069.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Jun Su, Chief Doctor, Department of Infection Disease, First Hospital of Quanzhou Affiliated to Fujian Medical University, No. 250 East Street, Licheng District, Quanzhou 362000, Fujian Province, China. su2366@sina.com
Received: September 28, 2020
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Hepatocellular carcinoma, Hepatitis B virus, Entecavir, Pegylated interferon alfa-2b, Clinical cure, Case report

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.