Elevated lactate impairs the efficacy of antiviral treatment on post-hepatectomy survival for advanced stage hepatitis B virus?–?related hepatocellular carcinoma - 17/09/18

Doi : 10.1016/j.clinre.2018.08.008

Jianping Zhao ^a, Jingjing Wang ^b, Songshan Chai ^a, Yuxin Zhang ^a, Wanguang Zhang ^a,^⁎
^a Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^b Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

^⁎Corresponding author. No. 1095 Jiefang avenue, Wuhan, Hubei province 430030, China.No. 1095 Jiefang avenueWuhanHubei province430030China

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 September 2018
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Highlights

•	NAs have a risk of mitochondrial toxicity and then inducing the increase of lactate.
•	NAs improve the long-term outcomes of HBV-related HCC after curative liver resection.
•	NAs could not improve the prognosis of advanced stage HBV-related HCC for elevated lactate.
•	The progression of HCC and NAs could induce the increase of lactate in advanced HCCs.
•	Elevated lactate predicts bad prognosis for HBV-related HCC after curative liver resection.

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Summary

Background

Nucleoside and nucleotide analogues (NAs) have a risk of mitochondrial toxicity and then inducing the increase of lactate. We aim to evaluate the impact of lactate on the effects of NAs therapy in hepatitis B virus-related hepatocellular carcinoma (HCC) patients after curative liver resection.

Materials and methods

Five hundred and fifty-seven HBV-related HCC patients were divided into the treatment and control group according to whether they received NAs therapy or not. Perioperative and prognosis data were retrospectively reviewed.

Results

The treatment group had a better overall survival rate (OS) than the control group (P = 0.017). The recurrence-free survival rate (RFS) did not significantly differ between the two groups (P = 0.174). NAs could improve the OS of early stage HCC patients (P = 0.028), as well as the OS of advanced stage HCC patients with low level of lactate in subgroup analysis stratified against the level of lactate (P = 0.037). Advanced stage HCC patients in the treatment group had a higher value of lactate than those in the control group (P = 0.024). Besides, advanced stage HCC patients had a higher value of lactate than early stage HCC patients in the treatment group (P < 0.001), as well as in the control group (P < 0.001).

Conclusions

NAs could improve the long-term outcomes of HBV-related HCC patients after curative liver resection. However, the improvement effect of NAs therapy is counteracted by the adverse effect of elevated lactate in advanced stage HBV-related HCC patients.

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Keywords : Hepatitis B virus, Hepatocellular carcinoma, Nucleotide and nucleotide analogues, Lactate