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Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 874–883 | Cite as

Antiplatelet Therapy is Associated with a Better Prognosis for Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma after Liver Resection

  • Pei-Chang Lee
  • Chiu-Mei Yeh
  • Yu-Wen Hu
  • Chun-Chia Chen
  • Chia-Jen Liu
  • Chien-Wei Su
  • Teh-Ia Huo
  • Yi-Hsiang Huang
  • Yee Chao
  • Tzeng-Ji Chen
  • Han-Chieh Lin
  • Jaw-Ching Wu
Hepatobiliary Tumors

Abstract

Background

Recurrence of hepatocellular carcinoma (HCC) with unsatisfactory survival is common after surgical resection. Antiplatelet therapy with aspirin or clopidogrel was recently shown to prevent hepatic carcinogenesis in a murine model, but its effect in humans had not been clarified. This study aimed to investigate the association between antiplatelet therapy and the outcomes for patients with hepatitis B virus (HBV)-related HCC after liver resection.

Methods

By analyzing data from the Taiwan National Health Insurance Research Database, 9461 HBV-related HCC patients who had undergone liver resection between January 1997 and December 2011 were identified. After one-to-four matching by sex, age, and propensity score, 442 patients with antiplatelet therapy and 1768 patients without antiplatelet therapy were enrolled for the analysis. The Kaplan–Meier method and modified Cox proportional hazards models were used for survival and multivariable, stratified analyses.

Results

Recurrence-free survival and overall survival after resection surgery were significantly better after 5 years in the treated cohort than in the untreated cohort (52.8 vs 47.9 %; p = 0.021 and 80.3 vs 65.4 %; p < 0.001, respectively). Besides, antiplatelet therapy reduced the risk of HCC recurrence (hazard ratio [HR] 0.73; p < 0.001) and overall mortality (HR 0.57; p < 0.001) in the multivariable analysis. However, antiplatelet use significantly increased the risk of upper gastrointestinal bleeding (odds ratio [OR] 1.91; p < 0.001).

Conclusions

Use of aspirin or clopidogrel was associated with better recurrence-free survival and overall survival among patients with HBV-related HCC after liver resection. However, these agents should be used with caution due to the adverse effects of upper gastrointestinal bleeding.

Keywords

Overall Survival Clopidogrel Propensity Score Liver Resection Antiplatelet Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Grants were received from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (MOHW105-TDU-B-211-124-001) in Taipei, Taiwan.

Disclosure

There are no conflicts of interest.

Supplementary material

10434_2016_5520_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 24 kb)
10434_2016_5520_MOESM2_ESM.tif (14 mb)
Supplementary material 2 (TIFF 14328 kb). Selection of Study Cohort. HCC, hepatocellular carcinoma; HBV, hepatitis B virus.
10434_2016_5520_MOESM3_ESM.tif (3.8 mb)
Supplementary material 3 (TIFF 3935 kb). Recurrence-free Survival and Overall Survival of HCC After Surgical Resection in Aspirin-treated Patients. HCC, hepatocellular carcinoma.

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Pei-Chang Lee
    • 1
    • 2
    • 3
  • Chiu-Mei Yeh
    • 4
  • Yu-Wen Hu
    • 2
    • 5
    • 6
  • Chun-Chia Chen
    • 2
    • 7
  • Chia-Jen Liu
    • 2
    • 6
    • 8
  • Chien-Wei Su
    • 2
    • 7
  • Teh-Ia Huo
    • 1
    • 7
  • Yi-Hsiang Huang
    • 7
    • 9
  • Yee Chao
    • 2
    • 5
  • Tzeng-Ji Chen
    • 2
    • 10
  • Han-Chieh Lin
    • 2
    • 7
  • Jaw-Ching Wu
    • 9
    • 11
  1. 1.Institute of PharmacologyNational Yang-Ming UniversityTaipeiTaiwan
  2. 2.Faculty of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Division of Gastroenterology and Hepatology, Department of Medicine, Yuanshan BranchTaipei Veterans General HospitalYilanTaiwan
  4. 4.Department of Family MedicineTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Institute of Public HealthNational Yang-Ming UniversityTaipeiTaiwan
  7. 7.Division of Gastroenterology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  8. 8.Division of Hematology and Oncology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  9. 9.Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan
  10. 10.Institute of Hospital and Health Care AdministrationNational Yang-Ming UniversityTaipeiTaiwan
  11. 11.Division of Translational Research, Department of Medical ResearchTaipei Veterans General HospitalTaipeiTaiwan

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