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Fung et al. Hepatoma Res 2017;3:284-93                               Hepatoma Research
           DOI: 10.20517/2394-5079.2017.38
                                                                                                  www.hrjournal.net
            Topic: Management of Huge and Advanced Hepatocellular Carcinoma                     Open Access

           The role of oral antiviral therapy in hepatitis

           B-related hepatocellular carcinoma



           James Fung 1,2,3 , Kenneth S.H. Chok 2,3,4

           1 Department of Medicine, The University of Hong Kong, Hong Kong, China.
           2 The Liver Transplant Center, Queen Mary Hospital, Hong Kong, China.
           3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
           4 Department of Surgery, The University of Hong Kong, Hong Kong, China.
           Correspondence to: Dr. James Fung, Department of Medicine, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
           E-mail: jfung@gastro.hk

           How to cite this article: Fung J, Chok KSH. The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma. Hepatoma Res
           2017;3:284-93.
                                         ABSTRACT

            Article history:              Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) in places where
            Received: 30 Aug 2017         chronic hepatitis B infection is endemic. Oral nucleos(t)ide analog (NA) therapy can reduce the risk
            First Decision: 14 Sep 2017   of HCC, but cannot completely prevent its development. For HBV-related HCCs, viral inhibition
            Revised: 3 Oct 2017           by NAs can  preserve  or improve  liver function, thereby increasing the  chance of  therapeutic
                                          intervention. After surgical resection, NAs can prevent reactivation of HBV, and also reduce
            Accepted: 7 Nov 2017          the chance of de novo development of HCC in the remnant liver. For those who undergo liver
            Published: 27 Nov 2017
                                          transplantation, NAs are essential to prevent reactivation and graft hepatitis, but is not likely to
            Key words:                    prevent HCC recurrence, which is due to metastatic disease. The role of NAs for non-curable
            Antiviral therapy,            advanced  HCC  is  less  well  defined.  These  include  patients  undergoing  locoregional  therapy,
            hepatitis B virus,            chemotherapy, or palliation. Although antiviral therapy can preserve liver function, which may
            hepatocellular carcinoma      be compromised by HBV, it is unable to prevent disease progression from HCC. At the time
                                          of HCC diagnosis, most patients will already be receiving NAs, and these patients should be
                                          maintained on therapy. For patients not on antiviral therapy at the time of HCC diagnosis, the
                                          decision to commence therapy is often determined by the stage of HCC and life expectancy.
                                          Patients undergoing curative therapy, or locoregional therapy/chemotherapy with reasonable life
                                          expectancy, should be commenced on antiviral therapy.

           INTRODUCTION                                       remains unclear, it is likely that HBV can promote the
                                                                                                      [3]
                                                              oncogenic process both directly and indirectly . Direct
                                                              mechanisms include the integration of HBV DNA into
           An estimated 240 million worldwide are currently   the host genome, leading to genomic instability and
           infected with the hepatitis B virus (HBV) and have   malignant transformation . The integration of HBV
                                                                                     [4]
           chronic hepatitis B (CHB) . In regions where CHB   DNA into genes responsible for cellular proliferation
                                   [1]
           infection remains endemic, HBV remains the leading   and differentiation may lead to uncontrolled cellular
                                                [2]
           cause of hepatocellular carcinoma (HCC) . Although   proliferation via altered expressions of oncogenes
           the exact mechanism of hepatocarcinogenesis        and tumor suppressor genes. In fact, integrated HBV
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