Preoperative antiviral therapy improves post-hepatectomy outcomes of patients with hepatitis B-related hepatocellular carcinoma

Background There was no standardized clinical guideline of the application of preoperative anti- Hepatitis B Virus therapy in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients receiving hepatectomy. This study explored HBV infectious impact on postoperative outcomes of HCC patients. Methods This retrospective study included 962 HCC patients who received hepatectomy from the Chronic Liver Diseases Perioperative Database (n = 360,767). Primary outcome was liver failure post-hepatectomy. Unsupervised consensus clustering classified HBV-related HCC patients into two clusters. A LightGBM model identified 15 factors linked to worse outcomes. Then, restricted cubic splines and logistic regression revealed that HBV DNA load was highly associated with liver failure. Results HBV-related HCC patients showed significantly higher liver failure (24.1% vs. 14.8%, p = 0.035) and severe complications (29.6% vs.18.5%, p = 0.019) compared to no HBV infection HCC patients after propensity score matching. The high HBV DNA load (≥ 3.679 log10 IU/mL) had 1.63-fold increased live failure risk (95% CI: 1.14–2.34). Preoperative antiviral therapy decreased live failure (OR: 0.30, 95% CI: 0.18–0.49) and severe complications (OR: 0.33, 95% CI: 0.22–0.51). The high HBV DNA load was associated with greater live failure risk among patients with either significant fibrosis [FIB-4 > 1.45 (OR: 2.01), APRI > 0.4 (OR: 1.87)] or impaired liver function [ALP > 147 U/L (OR: 3.89)]. Conclusion HBV positive with high DNA load is a risk factor of liver failure and severe postoperative complications in HCC patients undergoing hepatectomy. Antiviral therapy suppressing HBV DNA load below 3.679 log10 IU/ml should be recommended to hepatitis B virus infected patients before receiving liver surgery.